Managed care and dually eligible beneficiaries: challenges in coordination.
This article describes administrative issues and beneficiary perspectives on the delivery of medical services under Medicare+Choice (M+C) and/or Medicaid managed care organizations (MCOs) for dually eligible beneficiaries. We interviewed staff at nine health plans in four market areas in 2000 and 2001, and conducted beneficiary focus groups in 2001. The study reveals beneficiary confusion about the relationship between their dual coverage and managed care enrollment, and problems with care and benefit coordination across these arrangements, based on regulatory and administrative obstacles to effective benefit and care coordination for beneficiaries enrolled in these varied managed care arrangements.
Walsh
Edith G
EG
Research Triangle Institute, 411 Waverley Oaks Road, Suite 330, Waltham, MA 02452-8414, USA. ewalsh@rti.org
Clark
William D
WD
D019090:Case Management; D017047:Cost Sharing; D003669:Deductibles and Coinsurance; D004608:Eligibility Determination; D005249:Fees and Charges; D006801:Humans; D033181:Information Dissemination; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D008484:Medicaid / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D020398:Medicare Part C / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D013221:State Health Plans / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D014481:United States