Document Type

Dissertation

Degree

Doctor of Philosophy

Major

Political Science

Date of Defense

12-2-2010

Graduate Advisor

David Brian Robertson

Co-Advisor

Baybeck, Brady

Committee

Cheryl Asa

Porterfield, Shirley L.

Abstract

The U.S. Medicaid program is increasingly challenged by reductions in federal entitlement spending, a faltering private sector health insurance base, escalating health care expenditures and an aging and increasingly diverse population. Converging pressures on state Medicaid programs have challenged state policy makers to find new approaches to enhance program efficiency. One of these policy tools is the adoption of Medicaid managed care programs for individuals with chronic illness and disability, particularly important as these enrollees incur the highest health care costs. The increasing prevalence of chronic illness combined with the growth of households in poverty creates significant implications for Medicaid policy making. Consequently, Medicaid policies directly influence the health and well-being of millions of Americans. Although literature cites cost-containment as the genesis for the adoption and growth of managed care in state Medicaid programs (Hurley and Zuckerman 2003: 217), little research explores why the growth of Medicaid managed care varies among states. This study uses panel regression analyses of the fifty states to examine redistributive and developmental policy attributes associated with Medicaid managed care and identifies policy determinants influencing the use of managed care in state Medicaid programs. Spatial patterns of state Medicaid managed care programs for enrollees with chronic illness and disability will be assessed using spatial autocorrelation. This will provide a descriptive picture of the relationship among states. Outcomes reveal the enrollment rate of state Medicaid programs and the use of managed care for program enrollees with disability is significantly influenced by redistributive and demographic policy indicators. Examining spatial relationships among states with respect to the percent of comprehensive state Medicaid managed care programs for people with disability yields only moderate correlation. This research looks beyond more overt policy characteristics such as state wealth, to uncover more nuanced factors influencing the public welfare sector and the health and well-being of Medicaid enrollees.

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