Medicaid Managed Care Case Study

Over the last few decades, managed health care has revolutionized the way medicaid beneficiaries treat essential healthcare services such as family planning and parenthood programs. The term managed care is a health insurance plan or system that allocates the provisions, quality and cost of caring for an individual. It has an significant role when it comes to providing health care services to medicaid members and the ways it’s utilized. Managed care plans create contracts with health care providers and medical institutions that help provide services at a lower and more affordable cost to their members. Additionally, managed care plans tend to pay health care providers directly so that it’s members don’t have to pay out of pocket for services

Managed care plans are seperated into three different catergories: HMO (Health Maintenance Organization), PPO (Preferred provider organization), and last but not least, POS (Point of Service). HMOs are plans that only pay for care within a certain network of doctors. In the case of PPOs, the person covered normally pays more if they get care within the network. They also pay part of the cost if they go outside the network. Furthermore, POSs are plans that lets it’s member choose between an HMO or a PPO every time they need care.

Medicaid managed care offers members a chance to choose a medicaid program that is more equlivalently relevant to their lifestyles. It focuses primarily on preventional health care and provides members with an enviornment in which they could be stable, as well as, cared for. In the article by Mary Caffrey titled “Kaiser Report: Medicaid Managed Care Policies Can Limit Access to Long-Acting Contraception”, she elaborates on her findings in the Kaiser Reports, including their findings as well. She analyzes how medicaid managed care policies can limit the access to long-acting contraceptives, ultimately affecting low-income women. Thanks to the progression of the Affordable Care Act (ACA), more individuals qualify for

Things such as parenting, breastfeeding and consultation programs, which arent usually provided by MCOs, are left almost entirely to low-cost insitutions, which explains the reason why most MCO plans have contracts with Planned Parenthood. Just recently with the sovereignty of the Trump administration, some members of congress are trying to block $500 million in funding for planned parenthood, in efforts to termination facilities that offer abortion next to other services. Since states have dominate control when it comes to regulating LARC and other contraceptives, the reduction of funding will impact the methods offered by MCOs, which tends to be beyond those resources avaliable for a fee. As a result, women who have lower income will not be aware of other alternative methods of reproduction. “ Most plans will only cover birth control pills for 3 months on a single prescription, despite evidence that giving women a 6- or 12-month supply reduces the risk of unintended pregnancy.” (Caffrey, 2017) This only adds to the encumbrance of women who earn lower