The health of the medical safety net: A ten-state study on the effect of managed care Medicaid

American democracy is founded on the principle of a balance of power between the national government and the states. In recent decades, there has been increasing momentum to shift the balance away from the national government and to devolve greater responsibility to the states. One major experiment of devolution has been the introduction of a managed care model to the Medicaid program.; This study examines the impact various models of Medicaid managed care have on the medical safety net. By definition, the managed care model's role is to contain the costs of health care delivery through a variety of measures, including contracting networks of providers and predetermining fixed payments for health services. As a result, traditional safety net institutions risk losing insured clients to managed care networks. Waning political and financial support can result as the focus shifts to managed care.; The research presented examines the relationship between Medicaid managed care and the safety net in ten states. It is a qualitative analysis based on field network evaluation research carried out by research teams for a Rockefeller Institute of Government study. State field network evaluation reports were used to create state profiles defining the types of Medicaid managed care arrangements and the current condition of the medical safety net. Matrices outlining managed care arrangements in each state and factors exerting pressure on the safety net are presented, and a cross-case analysis is conducted. Finally, an assessment of the relationship between the Medicaid managed care arrangements and the degree of pressure exerted on the safety net is offered.; Among multiple plausible relationships explored through the analysis, the importance of agency location (within a health or welfare agency) to the success of Medicaid managed care and the effect of existing state support on the stability of the safety net are significant. The research shows that organizational culture, context and priorities impact the success of both managed care and the safety net. The final analysis suggests opportunities for future research that can build on this study by including those factors identified as significant to the success of both the safety net and managed care.