The Paradigm Shift in Medicaid

Download or read book The Paradigm Shift in Medicaid written by Katherine Marconi and published by . This book was released on 2010 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Publicly-funded health care is undergoing a paradigm shift as Medicaid converts from fee-for-service systems to managed care plans. This shift to capitated reimbursement affects the methods that women, including those with HIV, use to access primary health care and related specialty care. This article addresses three issues of importance to the HIV/AIDS care of women under Medicaid managed care systems: changes concerning access to services needed by women; how coordinated quality services will be delivered; and whether reimbursement rates will be sufficient to cover the costs of care. It first reviews Federal legislation that has disconnected Medicaid from general assistance and given states more authority in structuring services. It then describes the HIV/AIDS epidemic in women in the United States and summarizes findings from the research literature on care seeking behaviors of women with HIV. Because there is limited experience with the delivery of publicly funded managed care to women with HIV, related- research is limited. The paper concludes by posing four challenges for the federal government in assuring quality HIV health care to women. First, is assuring that state plans allow access of women to newly developed pharmaceuticals, especially through clinical trials. A second challenge includes adequate review and monitoring of state waivers for public care to assure the access of women to appropriate medical services, such as gynecological care. Additional challenges include developing of support services that enhance women's access to primary health care and monitoring other HIV/AIDS Federal funding streams, such as The Ryan White CARE Act, to understand how such programs should interact with publicly-funded managed care. Because of the complexity and diversity of state Medicaid and related programs, federal monitoring is essential. Otherwise, notwithstanding the opportunities afforded by the paradigm shift in public funding, cost containment principles will be achieved at the expense of women's health care.