To receive such a waiver, states must prove that these plans have the capacity to serve Medicaid beneficiaries who will be enrolled in the plan. Section 1115 demonstrations allow states to test new approaches to benefits, services, eligibility, program payments, and service delivery, often on a statewide basis. These approaches are frequently aimed at saving money to allow states to extend Medicaid coverage to additional low-income and uninsured people. When all 15 are implemented, 2.2 million previously uninsured individuals are expected to receive health coverage. As the number of beneficiaries enrolled in managed care plans has increased, the Clinton Administration has been working closely with states, insurers, health care professionals, and consumers to assure the quality of care provided in that setting.
Several initiatives are already underway.
The new measures will help plans to improve the quality of their care and support efforts to improve the health status of beneficiaries. In July 1993, QARI issued A Health Care Quality Improvement System for Managed Care, providing states with a broad range of Federally-recommended guidelines for building and operating quality assurance and improvement systems. These guidelines were tested in three states in 1993-95 by the Kaiser Family Foundation and the results were issued in 1995 through the National Academy for State Health Policy's Quality Improvement Primer for Medicaid Managed Care. The regulations also ban any incentive arrangements that include payments to doctors to limit or reduce medically necessary services. These rules are designed to make sure incentives to discourage unnecessary services do not go too far.