MEDICAID MANAGED CARE: KFF Looks at Oregon, Tennessee

      A new report from the Kaiser Family Foundation tracks the evolution of managed care in Tennessee and Oregon and expansions to cover low-income populations in these two states (Kaiser release, 9/99). Noting that TennCare has "evolved considerably" across the past four years, researchers point to strengthened administrative systems for quality and financial oversight, continued participation by managed care plans and extended coverage to an additional 130,000 uninsured people as signs of success. However, they question the program's "long term viability," as the "financial status of participating plans has deteriorated ... [and] the state has not devoted the funding necessary to enable TennCare to achieve its coverage objectives" (Four Years' Experience With TennCare, 5/99). In addition, many view TennCare Partners, created in 1996 to provide coverage for behavioral health care, as "having fundamental flaws" and causing the deterioration of access to "mental health services for the seriously and persistently mentally ill" (The Tennessee Experience, 5/99). Researchers are more optimistic about the Oregon Health Plan (OHP), calling it an "encouraging experience at a time when many states are moving to introduce managed care more broadly into their Medicaid" programs. Notes the report, "Staggered program implementation and the involvement of all interested parties in the planning stages contributed to community buy-in and a generally smooth transition." The plan's main challenge, according to Kaiser, lie in "creating a sound information infrastructure to support better risk adjustment; developing techniques for dealing with care coordination issues associated with the dually diagnosed; and securing the continuing cooperation of all stakeholders" (Four Years' Experience with the OHP, 5/99).