The growth of managed medical care has forever changed the face of the U.S. healthcare system. While for many years managed care was largely confined to the commercially insured population, in the past decade there has been rapid growth in the enrollment of Medicaid-eligible individuals into managed care plans. While a multitude of studies have been performed to assess the impact of managed medical care in the private arena, relatively little evaluative work has been done with regard to the enrolled Medicaid population. Even less research has been done to assess the consequences of Medicaid managed care on the traditional providers of service for these populations.
During the past three decades a network of community health centers has developed in our country to provide medical care to millions of the nation's low income and uninsured. By virtue of their geographic location and the populations that they serve, many of these centers qualify for federal grants and enhanced reimbursement through Medicaid and Medicare. Such centers are designated Federally Qualified Health Centers (FQHCs). There are approximately 60 FQHCs located in the state of Texas, and these are supported by HRSA's Dallas regional field office.
Texas initiated its first Medicaid managed care pilot program in 1993. Known as the STAR program (State of Texas Access Reform), Medicaid managed care is in the midst of a state-wide phase in, due to be completed in 2002. At the present time approximately 400 thousand of the state's estimated 1.5 million Medicaid eligible citizens are enrolled in managed Medicaid.
For a number of reasons, FQHCs have not traditionally been "partners" in managed care programs. With the pronounced shift of one of their core constituencies into these new models it has become imperative that FQHCs be included on managed care panels. These new relationships require significant adjustment in the processes of care and the financial management of these health centers.
There were 2 phases of data collection for this project:
1) Review of grant renewal and continuation applications (and the associated financial statements) of the FQHCs located in each region of Texas that has implemented the STAR program.
2) Telephone survey of the directors of these FQHCs (or their designee) regarding their experiences in adapting their centers to the managed care environment.
Medicaid managed care, along with other concurrent changes in the health care environment, has had significant impact on both financial and clinical aspects of Community Health Centers in Texas. This study identified various problems common to health centers during and after the transition to managed care. Benefits of managed care involvement were also identified. A number of recommendations are made regarding useful groundwork for health centers to undertake in order to maximize their chances of competing successfully in a managed care environment.
U.S. Health Resources and Services Administration’s (HRSA) Dallas Regional Field Office