The Impact of Medicaid Managed Care Plan Type on Continuous Medicaid Enrollment: A Natural Experiment

Objective: To assess the impact of assignment to a Medicaid-focused versus mixed managed care plan on continuity of Medicaid coverage.

Data sources: 2011-2016 Medicaid claims from a Northeastern state.

Study design: Following the exit of a Medicaid managed care insurer, Medicaid administrators prioritized provider networks in reassigning enrollees, but randomly assigned beneficiaries whose providers were equally represented in the two plans. We leveraged the natural experiment created by random plan assignment and conducted an instrumental variable analysis.

Data collection: We analyzed Medicaid claims for 12,083 beneficiaries who were members of the exiting Blue Cross Blue Shield plan prior to January 1, 2011.

Principal findings: Managed care plan type did not significantly impact continuous enrollment in the Medicaid program. Greater outpatient utilization and the presence of a special need among children were associated with longer enrollment in Medicaid.

Conclusions: Managed care plans did not differ in their capacity to keep Medicaid beneficiaries continuously enrolled in coverage, despite differences in plan features.