Medicaid Managed Care: Serving the Disabled Challenges State Programs. Report tothe Chairman and Ranking Minority Member, Subcommittee on Medicaid and Health Care for Low-Income Families, Committee on Finance, U.S. Senate

摘要

Prepaid managed care plans, which deliver medical services for a fixed (or'capitated') per-person fee, are an increasingly common part of Medicaid, the nation's largest health care program for the Poor. With their emphasis on Primary care, restricted access to specialists, and control of services, prepaid plans are seen as a way to help control spiraling Medicaid costs, which totaled $159 billion in fiscal year 1995. Thus far, states have extended prepaid care largely to low-income families-about 30 million individuals-but to few of the additional 6 million Medicaid beneficiaries who are mentally or physically disabled. Managed care's emphasis on primary care and control of service use differs from the care needs of disabled beneficiaries-many of whom need extensive services and access to highly specialized providers, which in some cases are essential to prevent death or further disability.