Incentives in a Specialty Care Carve-Out

by Moira Inkelas

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This study examines the impact of a payment strategy for specialty services in a transition to Medicaid managed care. It presents results from a natural experiment created when California expanded participation in Medicaid managed care, and excluded certain specialty services for children with qualifying medical diagnoses. The study describes the policy's impact on caseloads and expenditures and includes a qualitative evaluation.

Table of Contents

  • Chapter One


  • Chapter Two

    Background on Payment Incentives and Carve-outs

  • Chapter Three

    Background to the Policy Evaluation

  • Chapter Four

    Research Design and Methods

  • Chapter Five

    Impact of Carve-out Policy on Title V Case-Finding

  • Chapter Six

    Impact of Carve-out Policy on Medicaid Expenditures

  • Chapter Seven

    Contextual Analysis of Carve-out Policy

  • Chapter Eight

    Conclusions and Policy Implications

  • Appendix A

    Medi-Cal and County Characteristics

  • Appendix B

    Issues in Tabulation Claim Expenditures and Identifying Unique Claimants

  • Appendix C

    Pre Carve-out Time Trend for Expansion and Non-expansion Counties

  • Appendix D

    Monthly Claimants with Claims in Diagnosis Categories

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