Jm. Johnston et Bs. Romzek, Contracting and accountability in state medicaid reform: Rhetoric, theories, and reality, PUBL ADM RE, 59(5), 1999, pp. 383-399
Medicaid reform, which has been central to state government reform througho
ut the United States, represents conceptual and implementation challenges f
or practitioners and scholars. This article investigates one such reform, i
n Kansas, where the state contracted with nonprofit agencies for Medicaid c
ase management services We examine policy rationales for this social servic
e reform in light of the actual economic and management environments. We of
fer a typology of contract management complexity which articulates how stru
ctural factors affect contract management challenges; it indicates that thi
s social service reform presents substantially greater complexity than more
traditional service contracting. Our analysis shows that key aspects of th
e market model of contracting are absent in this reform, reflecting a gap b
etween the political rhetoric which surrounds the reform and the reality of
the contracting experience. The lack of market conditions to impose discip
line an contractors raises questions about contract management capacity and
administrative accountability. The level of management complexity suggests
the need for well trained contract management staff and especially sensiti
ve accountability structures to facilitate contract monitoring and minimize
principal-agent complications.