Does everyone on Medicaid join a managed care plan?
Since the early 1980s, state have experimented with various managed care approaches to reduce unnecessary utilization, contain costs, improve access to services, and achieve greater coordination and continuity of care. In 1991, fewer than 10 percent of all Medicaid enrollees were covered under managed care plans. By 1998, nearly 54 percent of the Medicaid population was enrolled in some type of managed care plan. Managed care is characterized by enrollment of individuals with a specific health plan, contractual agreements between the plan and the state Medicaid agency, and gatekeeping and utilization control by primary care physicians or nurses. The way managed care operates varies greatly across the states and for different populations. States use diverse managed care models, ranging from fully capitated, risk-based plans to fee-for-service primary care case management arrangements. Some states enroll most beneficiaries in “full-risk” plans in which the health plan provides all covere
