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1993.
10.18 :  Medicaid Managed Care Increase

Contact: Anne Verano (202) 690-6145
October 18, 1993

     The number of Medicaid recipients in managed-care plans
increased nearly 33 percent during the past year and has more than
doubled since 1990, HHS Secretary Donna E. Shalala announced today.
     "We are very pleased to see the continued strong growth in the
use of managed-care options for the Medicaid population," Secretary
Shalala said.
     Managed-care plans, which include health Maintenance
organizations and other arrangements, are now used by 42 states to
serve Medicaid recipients.  Medicaid enrollment in such plans has
reached 4.81 million this year, up from 3.63 million in 1992.
     "States are looking to managed care as a better way to
coordinate access to appropriate, quality health care for Medicaid
recipients," said Bruce C. Vladeck, administrator of the Health
Care Financing Administration, which oversees the Medicaid and
Medicare programs.
     "Persons receiving Medicaid -- the majority of whom are poor
women and their children -- are especially vulnerable to problems
in gaining access to appropriate health care," Vladeck said.  "Very
often the hospital emergency room is the only available source of
care for these individuals.  Managed care has the potential to
change that."

     HCFA requires that Medicaid managed-care plans meet federal
quality standards and cost no more than the amount that would be
spent on comparable fee-for-service care.
     Much of the growth in Medicaid managed care reflects increased
enrollment in HMOs and primary care case management programs.
     Under case management, physicians contract with the state to
be responsible for primary care for specific Medicaid recipients
and for coordinating referrals for any needed specialist or
hospital care.  HMOs and other prepaid health plans contract with
a state to provide all or part of the Medicaid benefit package on
a prepaid risk basis.
     About 33 million people are enrolled in the Medicaid program,
under which the federal government provides matching funds to the
states to help finance health care services for the poor.