Teresa A. Coughlin, MPH¹, Alshadye Yemane, BA¹, and Sharon K Long, PhD². (1) Health Policy Center, Urban Institute, 2100 M Street N.W., Washington, DC 20037, 202-261-5356, ayemane@ui.urban.org, (2) Health Policy Center, The Urban Institute, 2100 M Street, NW, Washington, DC 20037

One goal of many state Medicaid managed care programs is to increase beneficiaries’ access to quality healthcare by “mainstreaming” patients into private care settings. A key factor in achieving this goal is the participation in Medicaid of commercial health plans since they have access to a broader provider network than do traditional Medicaid systems. While the rapid increase in Medicaid managed care enrollment during the early to mid-1990s attracted many commercial health plans to Medicaid, in the late 1990s, many state programs began to experience a steady decline in commercial plan participation. A number of qualitative studies have documented possible reasons for this exodus, but few studies have used econometric methods to isolate the relative importance of the various factors that affect the participation decision. Using 2000 and 2001 plan-level data from InterStudy, this study uses multivariate methods to determine the extent to which the following factors contribute to plan exits from Medicaid managed care: plan characteristics (e.g., enrollment levels and for-profit status); county healthcare market conditions (e.g., provider supply, managed care competition, and reimbursement levels for Medicaid and its substitutes, i.e., Medicare and the private market); and Medicaid program characteristics (e.g., size of county Medicaid population, presence of carve out programs, use of enrollment brokers, and existence of plan lock-in or guaranteed eligibility policies).

Learning Objectives:

• By identifying the key factors that contribute to plan exits from Medicaid managed care, this paper provides state officials with insight into policy options that could prevent the future loss of commercial managed care plans from the Medicaid program.

Keywords: Medicaid Managed Care,

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.