United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 1998-10-21 monographic deposited born digital 108 p. GA 1.13:HEHS-99-8 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-99-8 P0b002ee180381088 f:he99008 DGPO 2010-08-12 2011-03-28 GAOREPORTS-HEHS-99-8 machine generated eng fdlp REPORT GAOREPORTS-HEHS-99-8 HEHS-99-8 Foster children State-administered programs Health care cost control Management information systems Health resources utilization Managed health care Health services administration Medicaid Program Aid to Families with Dependent Children Program Statewide Automated Child Welfare Information System Supplemental Security Income Program Hamilton County (OH) California Colorado Georgia Maryland Minnesota New York North Carolina North Dakota Ohio Pennsylvania Virginia Wisconsin Kansas Massachusetts Florida Chapter Report HEHS 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.<p/>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. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-99-8/html/GAOREPORTS-HEHS-99-8.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-99-8/pdf/GAOREPORTS-HEHS-99-8.pdf GAO/HEHS-99-8 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-99-8 Chapter Report GAO/HEHS-99-8; Child Welfare: Early Experiences Implementing a Managed Care Approach; Foster children State-administered programs Health care cost control Management information systems Health resources utilization Managed health care Health services administration Medicaid Program Aid to Families with Dependent Children Program Statewide Automated Child Welfare Information System Supplemental Security Income Program Hamilton County (OH) California Colorado Georgia Maryland Minnesota New York North Carolina North Dakota Ohio Pennsylvania Virginia Wisconsin Kansas Massachusetts Florida Public Law 96-272 Public Law 104-193 Public Law 105-89