Child Welfare:

Early Experiences Implementing a Managed Care Approach

HEHS-99-8: Published: Oct 21, 1998. Publicly Released: Oct 21, 1998.

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Cynthia Maher Fagnoni
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Pursuant to a congressional request, GAO reviewed the states' efforts to implement managed care into their child welfare systems, focusing on determining the: (1) extent to which public agencies are using managed care to provide child welfare services; (2) financial and service delivery arrangements being used under a managed care approach; and (3) challenges child welfare agencies face as they develop and implement managed care, and the results of such efforts to date.

GAO noted that: (1) nationwide, public child welfare agencies have implemented managed care projects or initiatives in 13 states, with new initiatives being planned or considered in more than 20 other states; (2) most of the ongoing initiatives involve foster children with the most complex and costly service needs; (3) currently, only about 4 percent of the nation's child welfare population is being served under managed care arrangements; (4) public agencies have contracted with experienced nonprofit, community-based providers in their service systems to implement managed care initiatives; (5) for-profit managed care companies have not had a major role in implementing managed care in child welfare; only a few jurisdictions are using for-profit companies to administer and provide child welfare services; (6) the majority of the ongoing child welfare managed care initiatives have established a capitated payment system; (7) lacking experience and uncertain about the feasibility of new fixed payments, some initiatives also use mechanisms to limit the financial risk that has been shifted to providers; (8) managed care initiatives require service providers to organize and coordinate a full array of services to ensure that appropriate and necessary services are available to children and their families; (9) most of the public agencies responsible for the initiatives have transferred case management functions to private entities; (10) the public sector, however, continues to play an active role at strategic points throughout the service-delivery process; (11) to ensure that providers' cost-controlling strategies do not jeopardize service quality or access to care, public agencies use various quality assurance techniques to hold service providers accountable for outcomes; (12) as more public child welfare agencies move toward managed care, public officials and their private contractors face several challenges; (13) as they develop and implement a capitated payment method, agencies need to find ways to maintain adequate cash flow; (14) agencies face the difficult tasks of developing sound management information systems; (15) both public and private agencies face new responsibilities as some traditionally public functions shift to the private sector and new roles emerge; (16) these changes may require these agencies to develop new procedures for case management and program administration and to provide additional training for both public and private employees; and (17) despite these challenges, public officials are encouraged by some positive, though limited, early results from managed care initiatives.

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