Medicaid Contracting with Managed Care Plans

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Health Law is expected to boost Medicaid enrollees in managed care

Tonya Bauserman, who was insured by HealthCare USA, a health care plan managed by Medicaid, got a knee injury and sought medical assistance from Columbia. HealthCare USA failed to cater to her medical bills. Bauserman was annoyed with the incident. However, it is common because the number of physicians in the care units managed by Medicaid is not enough to adequately serve a large number of patients. HealthCare USA is owned by Coventry Health care. Mathew Eyles, the spokesman, stated that the company had good networks but assist patients but failed to give comments in the case of Bauserman. Medicaid federal program is established in the USA to deal with health matters of the poor and the disabled. HealthCare USA is a privately managed sector providing health care services to more than 50 million patients. The number keeps on increasing, and by 2014, it is approximated that the number will have increased by 16 million people.

The question of whether care managed by Medicaid is good for patients to remain a debatable issue because the enrolled people are only supposed to seek assistance within the plan’s network. In the traditional Medicaid, in which payment was offered for services provided, patients have the freedom of seeking medical assistance from any willing doctor. Some experts like James Verdier prefer traditional Medicaid because of the freedom to choose doctors, improved quality, and it is cost-effective. Managed care units are trying to expand their strategies to accommodate large numbers of patients because they have the opportunity.

Insurers Clash with Health Providers as States Expand Medicaid Managed Care

The number of Medicaid recipients in Florida is about 3 million. Activists of HMO and home nursing industries are working out bills generated by the large numbers of recipients. The nursing home representative wants to ensure efficient inclusion of all facilities in HMO long-term contracts. HMO representative has no problem with the nursing representative’s demands but is mainly concerned with the hospital. Hospitals in Florida are aiming at establishing hospitals to help in the management of Medicaid patients at low costs. The main challenge is competition for money and control of the institutions in the country. Half of the patients under Medicaid programs are in the private sector, where chances of choosing hospitals and doctors are limited. The rest have freedom of choice on where to go for medical help. Programs managed by Medicaid are growing. United Health Care has the largest number of patients. Nursing homes, hospitals, and doctors are highly opposed to the expansion plans. At the same time, patients are complaining about the quality of services they are getting.

Doctors in Louisiana and Maine require patients to register with managed care plans like HMO for fear of losing control over the program. Hospitals are also afraid of losing money funded by federal organizations to help in the treatment of poor people. Some of the countries making efforts to expand Medicaid programs include Mississippi, Texas, Michigan, South Carolina, and Illinois. Medicaid programs come second after public education in the Budget of Florida. The association of health plans in Florida is discouraged with the idea that hospitals are suggesting the creation of plans, yet they will suffer financial risks and requirements enforced by HMOs. Consumer supporters in Florida are concerned with the impacts that compulsory managed care will have.

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Medicaid Contracting with Managed Care Plans

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