Change in guard = change in Medicaid?

February 1, 2007

WITH changes on Capitol Hill and at the state level after 2006 mid-term elections, experts are expecting more focus on broadening Medicaid coverage.

"For many states, this means a heavier reliance on managed care," according to Larry Bridge, senior vice president of government programs for TriZetto. "Some states, such as Arizona, have its entire Medicaid population enrolled in managed care."

According to TriZetto, as of 2005, 63% of all Medicaid enrollees were in some form of managed care, with 41% in full managed care programs. "While the penetration of managed care in Medicaid has continued to grow over the past five years, the number of health plans participating in Medicaid managed care has shrunk," Bridge says.

While Bridge believes that the Medicaid pure-plays will continue to be successful, he is starting to see increased interest by the multi-lines-of-business players in getting back into Medicaid. "We believe that those health plans that have positioned themselves as hybrids, prepared technologically to take advantage of both commercial and government programs lines of business, will come out on top," he says. "WellPoint is a good example of this style of hybrid plan."

Other states have even more ambitious plans, combining Medicaid and managed care with broader reform to increase and modify coverage. "South Carolina is a good example, where Medicaid recipients are being provided personal health accounts so that they can 'purchase' the coverage they want," Bridge explains.

Shawn Jenkins, CEO of Benefitfocus, agrees that the most innovative states are encouraging this consumer involvement. "This includes sponsoring programs that promote good health and smart choices and allowing variations on health savings accounts for Medicaid recipients, giving them control over how they spend healthcare dollars," Jenkins says.

Patricia A. Cornett, EdD, MS, RN, senior vice president of Versant Advantage Inc., believes that states have been relying less on services and emphasizing independence and better symptom management in physical care, mental health and substance abuse.

"Since 2005, states have focused more on disease management, meaning good individualized follow-up to ensure clients are following drug or treatment regimens, which in turn decreases expensive acute care exacerbations because problems are identified and remedied early," Cornett says.

-Tracey Walker Commentary is independent of source data