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Commercial Health Plan Participation in Medicaid Managed Care: An Examination of Six Markets

Teresa A. Coughlin, Sharon K. Long and John Holahan
Inquiry
Vol. 38, No. 1 (Spring 2001), pp. 22-34
Published by: Sage Publications, Inc.
Stable URL: http://www.jstor.org/stable/29772931
Page Count: 13
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Since scans are not currently available to screen readers, please contact JSTOR User Support for access. We'll provide a PDF copy for your screen reader.
Commercial Health Plan Participation in Medicaid Managed Care: An Examination of Six Markets
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Abstract

This study examines six local health care markets to gain a better understanding of the factors associated with the decision by commercial plans to participate in Medicaid managed care (MMC). Findings suggest that no single factor explained why plans chose to participate in MMC in a particular market. Instead, a combination of factors—generally economic but not always—determined whether a plan participated. While rate adequacy was central, it was not the only factor. Results indicate that it is capitation rates relative to other factors (such as provider costs, administrative costs, enrollment volume, growth opportunities in other markets) that matter rather than simply the level of rates.

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