QUALITY MANAGEMENT BY STATE MEDICAID AGENCIES CONVERTING TO MANAGED CARE - PLANS AND CURRENT PRACTICE

Context.-Enrollment in Medicaid managed care plans has increased more than 5-fold in this decade, but how states monitor and encourage quali ty of care in these programs is not known. Objective.-To characterize the quality monitoring and assurance activities of state Medicaid agen cies for Medicaid beneficiaries enrolled in comprehensive prepaid mana ged care programs. Design.-Structured telephone survey conducted betwe en October 1996 and January 1997. Setting.-State Medicaid agencies. Pa rticipants.-Representatives from all state Medicaid agencies, includin g the District of Columbia, with beneficiaries enrolled in comprehensi ve prepaid managed care plans as of July 1, 1996. Main Outcome Measure s.-Proportion of states with specific quality monitoring and assurance activities for Medicaid managed care. Results.-We surveyed all 34 sta tes enrolling beneficiaries in comprehensive managed care programs. In 1996, all 34 states enrolled the population receiving assistance from the Aid to Families With Dependent Children (AFDC) program, while onl y 21 (62%) and 15 (44%) enrolled the disabled and elderly populations, respectively. In the period 1995 to 1996, 19 states (63%) collected d ata on satisfaction with care, and 25 states (83%) collected data on c hildhood immunizations, No more than half of the states collected data on other selected measures of access and quality, but a substantial n umber planned to collect such data in 1997, While at most 37% of state s were providing comparative data to health plans, up to 80% were plan ning to provide such information in 1997. Similarly, while at most 10% of states provided beneficiaries with such information, up to 38% pla nned to do so in 1997. The breadth of contracting requirements designe d to assure quality varied substantially across states. Conclusions.-S tate Medicaid agencies have already begun adapting to their new roles as purchasers of health care. Continued monitoring is essential to ens ure that state agencies implement planned programs and that quality of care for Medicaid enrollees is preserved or improved.