Policies and Strategies to Make Medicaid Managed Care Work for FQHCs: Experiences from Two States

State policies have a strong influence on the ability of Federally Qualified Health Centers (FQHCs) to participate in managed care arrangements. The 2000 Institute of Medicine report, “America’s Health Care Safety Net: Intact but Endangered,” examined the impact of Medicaid managed care on the future integrity and viability of safety net providers, such as community health centers. The report warned federal and state policy makers that managed care policies need to explicitly take into account the unique mission of safety net providers, reflected through fair rates and policies, lest the safety net structure be significantly weakened.

With this message in mind, the National Academy for State Health Policy (NASHP) visited two states in spring of 2008 with two different kinds of managed care programs (primary care case management and managed care organizations). Based on those site visits, this publication looks at Alabama’s and Michigan’s managed care policies and strategies particularly as they affect FQHCs with regard to:

• Enrollment and assignment;

• Access to providers;

• Monitoring and quality; and,

• Financing.

The site visits and health spolicy briefing were supported through a National Cooperative Agreement (Number U30CS09747-01-00) with the federal Health Resources and Services Administration, Bureau of Primary Health Care (HRSA/BPHC). This briefing and other project activities are intended to help inform state policy making as it affects community health centers in order to promote achievement of shared goals of improved access to quality, affordable, health care for our nation’s most vulnerable populations.

Medicaid Managed Care

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