In this project, we aim to assess the effects of the shift to managed care on long-term healthcare utilization and health outcomes using data from two large states, New York and Texas. Between 2004 and 2011, New York and Texas expanded managed care to SSI recipients in Medicaid county-by-county, providing sharp variation in managed care enrollment for this important group. Medicaid recipients with disabilities in some counties were forced to enroll in a managed care plan on a given date, while observably similar recipients in neighboring counties remained in the publicly managed fee-for-service program. In addition to providing clean variation in managed care enrollment, these states are also large and very different in terms of the generosity of their programs, allowing us to provide more generalizable results. Additionally, disabled Medicaid recipients are the ideal group for studying the consequences of managed care on health outcomes due to the complexity of their conditions and their low rates of “churn” out of the Medicaid program.
Out specific aims are:
Aim 1: Assess the consequences of enrollment in Medicaid managed care on healthcare utilization in Medicare among SSI recipients in New York and Texas.
Aim 2: Assess the consequences of enrollment in Medicaid managed care on health outcomes (mortality, avoidable hospitalizations, hospital readmissions) post-age 65 among SSI recipients in New York and Texas.