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Medicaid Plans Advantages and Disadvantages

Utilizing Medicaid plans within the SCHIP program has both advantages and disadvantages.

Advantages Include:

• More bargaining power with providers due to large number of beneficiaries.

• Use of one benefit package and one set of providers or plans.

• Removal of the need for tracking cost-sharing.

• Use of currently existing networks, data systems and contract mechanisms.

• Use of non-licensed, Medicaid-defined HMOs.

• Historical providers already familiar with needs of Medicaid population.

Disadvantages Include:

• SCHIP may place additional demand on an already strained system.

• The Medicaid delivery systems is still in transition to managed care.

• Medicaid managed care system problems (low rates, service incentives) have not been resolved.

• Traditional problems under the Medicaid fee for service (FFS) system are still not solved.

Related Questions

Compare or contrast this information

• Medicaid FFS Issues

• Separate State Plan Advantages and Disadvantages

Give me an overall context

• Describe Children’s Health Care Needs

• Overview of Service Delivery Statistics

Show me other SCHIP Workshop presenter-suggested strategies

• SCHIP Guidance - Strategies Suggested by Presenters

What led to this?

• Assessing Key Issues with Service Delivery

Who presented this material?

• Shelly Gehshan, M.P.P. and Denise Holmes