Abstract: In the course of the nation’s evolution toward managed care service delivery and financing models, state administration of Medicaid and other public sector health care services has become increasingly complex. Ten years ago, most state Medicaid programs paid providers directly under a fee-for-service model. The administration of a state Medicaid program involved low administrative overhead. It required the execution of simple Medicaid provider agreements, a contract with a Medicaid certified claims processing vendor, and the use of a not-so-aggressive utilization review operation to ensure compliance with medical necessity requirements. Most states used no mechanisms to contain explosive growth. They did attempt, however, to buffer the financial impact of program growth by maximizing federal cost sharing using strategies such as disproportionate share hospital payments. The administration of the Medicaid program easily could be accomplished on less than 5% of every Medicaid dollar. By 1999, all but nine states were operating at least one managed behavioral health care program, typically using capitation or other risksharing arrangements and mechanisms for managing utilization. 6 Ap
Publication Year: 2002
Publication Date: 2002-01-01
Language: en
Type: article
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