title: The Monterey County Health Initiative. A post-mortem analysis of a California Medicaid demonstration project.
abstract: Twenty months after the California State Department of Health Services turned its Medicaid program in Monterey County over to a local health care authority, the Monterey County Health Initiative (MCHI), the state terminated the pilot project in favor of a return to fee-for-service reimbursement. The MCHI, plagued from its inception with shaky provider support and a flawed program design, failed to demonstrate its anticipated cost savings. The key features of this failure were overly generous fees for primary case managers, inadequate utilization control measures, a general hesitancy to assume the necessary gatekeeper function, and a management information system that was not fully operational until well into the implementation of the program. Policy implications and recommendations for future state-sponsored Medicaid demonstration projects are discussed.
mesh_terms: D002140:California; D003363:Cost Control; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D008484:Medicaid / Q000191:economics*; D010865:Pilot Projects; D011320:Primary Health Care / Q000191:economics* / Q000458:organization & administration; D012041:Regional Medical Programs / Q000191:economics*; D012051:Reimbursement Mechanisms; D014600:Utilization Review / Q000191:economics