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March 10, 2004

Quality of Care in Medicaid Managed Care vs Commercial Managed Care Plans—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(10):1195-1197. doi:10.1001/jama.291.10.1196-c

In Reply: We agree with Drs Somers and Baron and with Ms O'Kane that there is a need for comparison of care received in traditional fee for service Medicaid plans and Medicaid managed care delivery, and stated this in our article. Indeed, comparisons of all components of our health care delivery system are warranted. Our project examined quality delivered to children in 2 components of our complex system—commercial and Medicaid systems of managed care.

Disparities in social and family resources, economic standing, and basic health unfortunately do exist between children privately insured and those served by Medicaid programs. However, managed care organizations (MCOs) agree to provide care to groups of enrollees as they exist, not in an idealized or optimal setting. Information regarding these general socioeconomic differences is obviously known and available to MCOs when contracting with states to provide care to children in Medicaid programs. We are not aware of any contractual caveats that excuse them from providing high quality of care to Medicaid enrollees comparable to that received by children in commercial managed care plans.

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