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A Tale of Two Cities? The Heterogeneous Impact of Medicaid Managed Care

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  • Marton, James
  • Yelowitz, Aaron
  • Talbert, Jeffrey
Abstract
Evaluating Accountable Care Organizations is difficult because there is a great deal of heterogeneity in terms of their reimbursement incentives and other programmatic features. We examine how variation in reimbursement incentives and administration among two Medicaid managed care plans impacts utilization and spending. We use a quasi-experimental approach exploiting the timing and county-specific implementation of Medicaid managed care mandates in two contiguous regions of Kentucky. We find large differences in the relative success of each plan in reducing utilization and spending that are likely driven by important differences in plan design. The plan that capitated primary care physicians and contracted out many administrative responsibilities to an experienced managed care organization achieved significant reductions in outpatient and professional utilization. The plan that opted for a fee-for-service reimbursement scheme with a group withhold and handled administration internally saw a much more modest reduction in outpatient utilization and an increase in professional utilization.

Suggested Citation

  • Marton, James & Yelowitz, Aaron & Talbert, Jeffrey, 2014. "A Tale of Two Cities? The Heterogeneous Impact of Medicaid Managed Care," MPRA Paper 54105, University Library of Munich, Germany.
    • Handle: RePEc:pra:mprapa:54105
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    Cited by:

    1. James Marton & Angela Snyder & Mei Zhou, 2016. "Enhanced Citizenship Verification And Children'S Medicaid Coverage," Economic Inquiry, Western Economic Association International, vol. 54(3), pages 1670-1683, July.
    2. Carole Roan Gresenz & Jean M Mitchell & Belicia Rodriguez & R. Scott Turner & Wilbert Van der Klaauw, 2024. "The Financial Consequences of Undiagnosed Memory Disorders," Staff Reports 1106, Federal Reserve Bank of New York.
    3. Lukas Kauer, 2017. "Long‐term Effects of Managed Care," Health Economics, John Wiley & Sons, Ltd., vol. 26(10), pages 1210-1223, October.
    4. Maria Apostolova‐Mihaylova & Aaron Yelowitz, 2018. "Health Insurance, Fertility, And The Wantedness Of Pregnancies: Evidence From Massachusetts," Contemporary Economic Policy, Western Economic Association International, vol. 36(1), pages 59-72, January.
    5. Tianyan Hu & Shin‐Yi Chou & Mary E. Deily, 2015. "Pregnancy outcomes for medicaid patients in mandatory managed care: The Pennsylvania HealthChoices program," Southern Economic Journal, John Wiley & Sons, vol. 82(1), pages 100-121, July.
    6. Lee, Ajin, 2020. "How do hospitals respond to managed care? Evidence from at-risk newborns," Journal of Public Economics, Elsevier, vol. 184(C).
    7. Elizabeth L. Munnich & Michael R. Richards, 2020. "Treatment flows after outsourcing public insurance provision: Evidence from Florida Medicaid," Health Economics, John Wiley & Sons, Ltd., vol. 29(11), pages 1343-1363, November.
    8. James Marton & Aaron Yelowitz, 2015. "Health insurance generosity and conditional coverage: Evidence from medicaid managed care in Kentucky," Southern Economic Journal, John Wiley & Sons, vol. 82(2), pages 535-555, October.
    9. Sean Orzol & Lindsey Leininger & Lauren Hula & Cara Orfield & Richard Chapman & Matthew Mleczko, "undated". "The Impact of Transitioning Stairstep Children from Separate CHIP to Medicaid on Use of Health Services: Evidence from Colorado and New York," Mathematica Policy Research Reports 599e8e49017642e0abf6a13fe, Mathematica Policy Research.
    10. Jonathan Gruber, 2017. "Delivering Public Health Insurance through Private Plan Choice in the United States," Journal of Economic Perspectives, American Economic Association, vol. 31(4), pages 3-22, Fall.
    11. Charles Courtemanche & James Marton & Benjamin Ukert & Aaron Yelowitz & Daniela Zapata, 2016. "Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States," NBER Working Papers 22182, National Bureau of Economic Research, Inc.
    12. Aaron Yelowitz, 2017. "Local housing costs and basic household needs," Empirical Economics, Springer, vol. 52(3), pages 901-923, May.

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    More about this item

    Keywords

    Medicaid; Managed Care; Child Health;
    All these keywords.

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs
    • J13 - Labor and Demographic Economics - - Demographic Economics - - - Fertility; Family Planning; Child Care; Children; Youth

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