Commercial Plans in Medicaid Managed Care: Understanding Who Stays and Who Leaves in a Changing Market Final rept

摘要

This study examines the extent to which Medicaid managed care (MMC) policies, plan characteristics, and local healthcare market conditions were associated with commercial plan exits from MMC between 2000 and 2001. We find that all three sets of factors contribute to a plans exit decision. Among the MMC policies, plans in counties with higher capitation payments and higher capitation growth rates were less likely to exit from MMC. Carve-outs for mental health services (which typically are not integrated with physical health care) made exits less likely, while carve-outs for prescription drugs (which are central to physical health care) made exits more likely. Plans in counties with mandatory enrollment into fully-capitated managed care for SSI beneficiaries were also more likely to exit. Regarding plan characteristics, we find that plans that are not-for-profit, provider-sponsored, and have more stringent restrictions on provider choice were less likely to exit from MMC. Finally, a higher profit potential in the overall managed care market was associated with a lower likelihood of exiting from MMC.