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Am J Public Health. 2002 Apr;92(4):598-610.

Safety-net institutions buffer the impact of Medicaid managed care: a multi-method assessment in a rural state.

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Department of Family and Community Medicine, University of New Mexico, 2400 Tucker Avenue, Albuquerque, NM 87131, USA.



This project used a long-term, multi-method approach to study the impact of Medicaid managed care.


Survey techniques measured impacts on individuals, and ethnographic methods assessed effects on safety-net providers in New Mexico.


After the first year of Medicaid managed care, uninsured adults reported less access and use (odds ratio [OR] = 0.46; 95% confidence interval [CI] = 0.34, 0.64) and worse barriers to care (OR = 6.60; 95% CI = 3.95, 11.54) than adults in other insurance categories. Medicaid children experienced greater access and use (OR = 2.11; 95% CI = 1.21, 3.72) and greater communication and satisfaction (OR = 3.64; 95% CI = 1.13, 12.54) than children in other insurance categories; uninsured children encountered greater barriers to care (OR = 6.29; 95% CI = 1.58, 42.21). There were no consistent changes in the major outcome variables over the period of transition to Medicaid managed care. Safety-net institutions experienced marked increases in workload and financial stress, especially in rural areas. Availability of mental health services declined sharply. Providers worked to buffer the impact of Medicaid managed care for patients.


In its first year, Medicaid managed care exerted major effects on safety-net providers but relatively few measurable effects on individuals. This reform did not address the problems of the uninsured.

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