Practices under pressure: Push toward Medicaid managed care

More and more states fighting budget crunches are putting Medicaid patients into managed care plans. How are their physicians coping?

By Amy Snow Landa, AMNews correspondent. Nov. 7, 2005.

As a pediatrician in San Antonio, Dianna Burns-Banks, MD, is well versed in the bureaucratic hassles of Medicaid HMOs. She encounters them almost daily at the South Texas Center for Pediatric Care, which she and a partner founded 17 years ago.

Sometimes her patients find, to their surprise, that they've been transferred by their HMO to another doctor at a different office. Or Dr. Banks-Burns discovers that she's been assigned new patients who would have preferred to stay with the doctor they'd been seeing.

"There's no logic to it," she said. "It means I have to stop seeing patients and take time to deal with it."

But that is the system into which all of her Medicaid patients will be transferred next year, when Texas plans to implement a Medicaid managed care expansion that includes making HMOs mandatory for all pregnant women and children covered by Medicaid who live in urban areas. In rural areas, these patients will move from fee for service to a managed fee-for-service model.

Texas physicians aren't the only ones witnessing a renewed shift toward Medicaid managed care. Many states, faced with ballooning Medicaid budgets, are looking at a variety of cost-control strategies, including capitated managed care plans.

On the national level, this could mean that Medicaid HMO enrollment is set to increase again, after having leveled off in recent years. "There was a little bit of a step back," said Joan Alker, a senior researcher at Georgetown University's Health Policy Institute. "But now it does seem there is a second wave of states ... who are considering it."