Brokering Medicaid is still a long way off for most counties

Trying to wrest control of Medicaid dollars from the states may not help county governments protect local providers from managed care, says a senior fellow at Mathematica Policy Research in Washington, DC.

But sharing Medicaid duties with states — maybe in ways other than purchasing — still allows counties to enhance the local system without bucking federal rules and statutes, says James Verdier, JD, in a study he recently completed for the Center for Health Care Strategies in Princeton, NJ.

Purchasing and conflict-of-interest regulations imposed by the Health Care Financing Administration are likely to impede counties’ efforts to take on Medicaid purchasing duties, says Mr. Verdier. At issue are federal purchasing regulations that encourage competition and look askance at any arrangement giving counties an exclusive franchise to broker Medicaid managed care. In addition, counties who want to both purchase and administer Medicaid services could run afoul of federal conflict of interest regulations, he suggests.

The variety of county involvement in Medicaid is staggering. In about three-fourths of the states, counties funded Medicaid services or provided them directly, usually through the local health departments or mental health centers. In almost half the states, counties performed Medicaid purchasing or administrative tasks, most commonly eligibility determination, according to Mr. Verdier’s 1998 survey of state Medicaid directors.

Contact Mr. Verdier at (202) 484-9220.