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Due to the increasing pressure to contain the rise of healthcare costs, it stands to reason that a narrow network of lower cost, high value providers should help bend the cost curve. But there are a host of factors that health plans must also consider. Does the adage “less is more” apply in this context?
Los Angeles County (“LAC”) California’s implementation of the Patient Protection and Affordable Care Act (“PPACA”) can serve as a case study for how effectively managed Medicaid plans and community clinics can come together to enroll and manage the cost of care for the newly insured.
The impact of the cost disparity between an employer-sponsored group health insurance policy and an individual health insurance policy has never been more apparent than in the recent legislation battles regarding the government-sponsored health insurance of Congress and its staff.
Presently 47 states and the District of Columbia have some form of managed care in their Medicaid Program.1 The purpose of this article is to provide attorneys in the healthcare arena an understanding of Medicaid managed care and some of the key legal issues associated with it.