Doctoral Dissertation Research in Political Science: The Politics of States' Medicaid Managed Care: 1981-1998

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The long term objective of this Doctoral Dissertation Research Investigation is to better understand how decisions with regards to program design made by state level policy makers affect the target populations use of state supported health care through Medicaid. Specifically, the research has the following goals: First, the research seeks to determine what environmental (health, economic, and social) and political factors shape the decisions of states to request Medicaid program waivers? Second, why do states vary in their design and complexity of managed care programs in Medicaid? Finally, do variations in managed care programs affect the delivery of health care? Specifically, does the access to care and the cost to state vary by design? To answer these questions multiple designs and statistical procedures will be employed. An event count approach using the 50 states from 1981 through 1998 provides an explanation of the determinants of an increased probability to obtain a waiver. To address the issues of program diversity, access, and cost a set of simultaneous equation models will be employed. Indices are created to serve both as independent and dependent variables. Health Care Financing Administration data as well as additional data collected by the Ph.D. student will be used in this study.