Commercial managed care plans leaving the medicaid managed care program inNew York State: Impact on quality and access

To develop sufficient managed care capacity to accomplish the goal of trans itioning Medicaid recipients into managed care, slate policymakers have rel ied on commercial health maintenance organizations to open their panels of providers to the Medicaid population. However, while commercial health main tenance organization involvement in Medicaid managed care was high initiall y, since 1996 New York State has had 14 commercial plans leave the New York State Medicaid Managed Care Program. It has been speculated that the exodu s of these commercial plans would have a negative impact on Medicaid enroll ees' access and quality of care. This paper attempts to evaluate the impact of this departure from the perspective of quality and access measures and plan audit performance. Univariate and multivariate analyses were performed to evaluation the effect of commercial managed care plans leaving the Medi caid program. The overall performance of plans that remained in the program was compared to that of the plans that chose to leave for the two lime per iods 1996-1997 and 1998-2000. Access to care, quality of care, and annual a udit performance data were analyzed. The departure of commercial health pla ns from the New York State Medicaid Managed Care Program has not had a stat istically significant negative effect on the quality of care provided to Me dicaid recipients as evaluated by standardized performance measures. In add ition, there were no instances when there was a negative impact of the exit of the commercial plans on access to care. Managed care plans that chose t o remain in Medicaid passed the Quality Assurance Reporting Requirements au dit at a significantly (P<.01) higher rate than plans that chose to leave.