State Medicaid programs can design delivery systems to provide services to beneficiaries that best fit their needs. Some states select fee for service (FFS), where the state agency pays providers directly for each covered service a beneficiary receives. Other states choose managed care approaches like full-risk capitation using a managed care organization (MCO).
Many states have incorporated full-risk managed care into their Medicaid programs for a variety of reasons, such as more control and predictability over costs or the prospect of better coordination efforts. However, some states may pursue an FFS approach instead. States may prefer to manage the program itself instead of paying higher administration costs that are associated with managed care or to retain control over care coordination and access to providers.
This panel shared the perspective of three states that use alternative approaches to contracting with full-risk MCOs. Panelists provided an overview of their state’s chosen delivery system approach, as well as their perspective on how this approach has affected quality and outcomes for beneficiaries. The panel also discussed the benefits and any challenges associated with their approach, and highlighted potential lessons learned for the Commission’s consideration.
Panelists included:
- William Halsey, LCSW, MBA, Deputy Director of Medicaid and Division of Health Services, Connecticut Department of Social Services
- Juliet Charron, MPH, Medicaid Division Administrator, Idaho Department of Health and Welfare
- Ashley Berliner, MPA, Director of Healthcare Policy and Planning, Vermont Agency of Human Services