title: Capitated Medicaid managed care in a rural area: the impact of Minnesota's PMAP program.
abstract: BACKGROUND
  Although states have had difficulty extending Medicaid managed care (MMC) to rural areas, rural models of capitated MMC are expected to grow in response to new federal regulations and the serious budget problems facing nearly all states. As such, understanding the effects of capitated MMC in rural settings is important for policy considerations.
  
  
  OBJECTIVE
  To evaluate the effects of capitated MMC on beneficiary access and use in rural Minnesota.
  
  
  METHODS
  We took advantage of delays in the timing of the introduction of MMC across rural counties in Minnesota to estimate the effects of managed care on adults and children under Medicaid using a difference-in-differences framework.
  
  
  RESULTS
  We found that Minnesota's shift from fee-for-service Medicaid to MMC in its rural counties had little effect on access to health care for either adults or children.
  
  
  CONCLUSIONS
  Because Minnesota reports that Medicaid costs under MMC are below expected costs under FFS Medicaid, it appears that the primary accomplishment of Minnesota's rural MMC initiative is one of cost savings: MMC provides the same access to care as FFS Medicaid, but at lower cost. With steep budget deficits in nearly all states, other states may want to consider Minnesota's rural MMC model as a mechanism for reducing their Medicaid costs.
authors.affiliation: Health Policy Center, The Urban Institute, Washington, DC 20037, USA. Slong@ui.urban.org
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Long
authors.forename: Teresa A
authors.initials: TA
authors.lastname: Coughlin
authors.forename: Jennifer
authors.initials: J
authors.lastname: King
mesh_terms: D000328:Adult; D002204:Capitation Fee / Q000706:statistics & numerical data; D002648:Child; D018588:Fee-for-Service Plans / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000706:statistics & numerical data*; D008484:Medicaid / Q000191:economics / Q000458:organization & administration*; D008910:Minnesota; D017061:Prepaid Health Plans / Q000191:economics / Q000706:statistics & numerical data; D012423:Rural Health; D019035:Rural Health Services / Q000191:economics*; D013221:State Health Plans / Q000191:economics / Q000458:organization & administration*; D013997:Time Factors; D014481:United States