Medicaid

Rising enrollment and spiraling costs are straining severely the government's main health care program for the poor. Although Medicaid was intended to make health care more accessible to the poor, program beneficiaries today often cannot find doctors willing to treat them. Nearly all states are trying to establish managed care programs, which rely on the primary care physician to provide, or arrange for, health care in a cost-conscious way. GAO surveyed Medicaid offices across the country and did detailed work in the following six states: Arizona, Kentucky, Michigan, Minnesota, New York, and Oregon. Managed care has the potential for improved access and quality, but questions persist about whether Medicaid beneficiaries actually achieve better outcomes under this system. Certain measures of access--such as office wait times and emergency room use--show improvements under managed care, and the quality of care provided to beneficiaries generally matches that of traditional Medicaid fee-for-service care. But better measures of medical outcomes still need to be developed and refined before the question of quality can be answered with any certainty. Finally, states report significant cost savings compared to fee-for-service programs, although some experts dispute these claims. Given the direction that states have chosen, their current challenge is to establish comprehensive data collection and monitoring systems to oversee their program. Safeguards need to be in place to identify health care providers who may be taking excessive financial risks and reduce needed services to beneficiaries.