Medicaid and managed care: implications for low-income women.

This commentary reviews Medicaid's role for low-income women and examines the implications of Medicaid managed care on the delivery of health services to this vulnerable population. Today 40% of the Medicaid population, mostly poor women and their children, is enrolled in managed care. Medicaid agencies are hoping managed care will control spending and address longstanding problems with access to care. Low-income women have a number of characteristics that make them doubly vulnerable to access to care and place them at high risk of health problems. Furthermore, many beneficiaries have historically experienced nonfinancial barriers to care under fee-to-service Medicaid. While many look to managed care to overcome these obstacles, the evidence suggests that it does not offer a great improvement over fee-to-service in terms of improved access or reduced long-term costs for low-income women. For Medicaid managed care to realize its potential, it must assure that financing is adequate, resources for monitoring and oversight are sufficient, and systems and benefits are responsive to the complex and diverse health care needs of low-income women.