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Chapter 4. In: Gavin NI, Farrelly MC, ed. Evaluation of Medicaid managed care programs with 1915(b) waivers. Presented to HCFA Office of R&D. Rockville, MD, USA: Research Triangle Institute:4-1 to 4-55.
Research Triangle Institute, Rockville, MD, USA
We chose Florida for our impact analysis of the Section 1915(b) waivers because of the mix of managed care arrangements for Medicaid beneficiaries in the State. Florida has become a hotbed of managed care development. The State encourages its Medicaid beneficiaries to enroll in health maintenance organizations (HMOs) In addition, under a Section 1915(b) waiver, the State implemented a primary care case management (PCCM) program, the Medicaid Physician Access System1 (MediPass), as the default Medicaid coverage for certain beneficiaries not choosing to enroll in HMOs. Those beneficiaries included Aid to Families with Dependent Children (AFDC) cash assistance recipients, other Medicaid-enrolled families with children, and pregnant women and children enrolled in Medicaid under the State Omnibus Budget Reconciliation Act (SOBRA) expansion categories.
The original waiver, which was approved in January 1990, covered a four-country pilot area around Tampa-St. Petersburg, including Hillsborough, Manatee, Pasco, and Pinellas Counties. In 1996, the State expanded MediPass to other counties and eligibility groups.2 However, this analysis is focused on the early experience of the program in the initial four-county implementation area and the original eligibility groups during the fiscal year running from July 1992 to June 1993 (FY93).
The experience of MediPass-eligible Medicaid beneficiaries in the four waiver counties in FY93 is compared to the experience of similar Medicaid beneficiaries in those counties in FY91 (prior to program implementation) and in four comparable counties in FY91 and FY93. The comparison counties – Lake, Orange, Osceola, and Seminole – comprise the four-county area around Orlando. These counties were considered the best match for the four-county Tampa/St. Petersburg area in terms of location in central Florida, size, and the inclusion of both urban and rural areas.
We used Medicaid enrollment and claims data to investigate MediPass participation and the success of the program in achieving the following four goals: (1) improving access to primary health care, (2) promoting the use of preventive care services, (3) changing patterns of service use, and (4) controlling Medicaid expenditures. Medicaid children (under 18 years of age) and adults (aged 18 years or more) were analyzed separately.
Because we were not able to obtain comparable encounter data for Medicaid beneficiaries who were enrolled in HMOs, we excluded beneficiaries with any HMO coverage during the study period from the analysis. Therefore, the estimated program impact is the effect of implementing a mandatory PCCM program over a traditional fee-for service (FFS) program among Medicaid beneficiaries who declined voluntarily HMO coverage.
1In 1996, the program was renamed the Medicaid Provider Access System.
2Coverage of non-Medicare-eligible SSI recipients began June 1996 and coverage of children in foster care and adoption subsidy arrangements began October 1996.