Health Policy Commons^™

Coverage Decision-Making In Medicaid Managed Care: Key Issues In Developing Managed Care Contracts, Sara J. Rosenbaum, Joel B. Teitelbaum

Health Policy and Management Issue Briefs

Coverage provisions are the most complex part of any managed care contract. This is particularly true for Medicaid agencies, because of important differences between Medicaid and insurance. This Issue Brief identifies general issues that should be addressed as managed care contracts are developed and drafted, and it specifically explores the challenges faced by public purchasers when drafting managed care coverage provisions.