April, 1999

Looking Back at the Promises of Medicaid Managed Care

This article was written by the Consumers Union Southwest Regional Office.

In Brief CU Review Determining Utilization & Quality of Care in Managed Care Plans Findings: Access & Quality of Care Data Quality Cost to the State Recommendations Common Acronyms Footnotes

Footnotes Texas Department of Health, Texas Medicaid Managed Care Report, FY 1997, December 1998. Blakely, Craig et al, Texas' Medicaid Managed Care Waivers Study: A Final Analytical Report, Public Policy Research Institute at Texas A&M University, June 1998. Hereinafter "(A&M)". Texas Health Quality Alliance, Texas Medicaid Managed Care, Retrospective Review, FY 97 State Report, (no date). And Texas Health Quality Alliance, Plan Report, Texas Medicaid Managed Care, FY 1997 Encounter Validation, February 5, 1999. Rudd and Wisdom, Estimated Financial Impact of Managed Care on the Texas Medicaid Program, November 2, 1998; Rudd and Wisdom, Impact of Managed Care on VDP Costs, December 3, 1998; and Rudd and Wisdom, Texas Department of Health, Cost Impact of Managed Care, March 12, 1999. National Heritage Insurance Company (NHIC), the state's claims administrator for Medicaid, has had significant data problems of its own. The NHIC system, while relatively complete, has never been flexible and researchers (including A&M) could not readily access the data for non-standard reports. However, before managed care the Form 2082 data produced from NHIC's claims database represented a complete picture of Medicaid program expenditures by type of recipient, recipient demographics, and basic service categories. That information is now unavailable for managed care populations. It must be noted here that we asked for documentation detailing the Rudd and Wisdom actuarial method for the FFS cost projections, including information about the underlying trend assumptions, and TDH told us that no such documentation exists. According to Texas A&M researchers, who used the Rudd and Wisdom method as the basis for their own analysis, no written reports of this method were available to them either. (A&M, Cost Analysis Methodological Report, p. 4) Form 2082, statewide fee for service cost figures for blind and disabled enrollees excluding vendor drug and long term care services.

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