Evolution of an Innovation: Variations in Medicaid Managed Care Program Extensiveness

Document Type


Publication Date

Fall 9-2012

Publication Source

Journal of Health Politics, Policy and Law





Peer Reviewed



This paper utilizes a theoretical framework of policy innovation, diffusion, and reinvention to investigate the evolving nature of Medicaid managed care programs over time. By estimating two separate models, one for Primary Care Case Management (PCCM) and a second for risk-based program enrollment, this study seeks to disentangle two different paths of learning, internal and external, investigate the potential effects of vertical diffusion of policy, and examine the impact of internal state characteristics on the extent of Medicaid managed care. With respect to diffusion and learning, the data reveal that earlier adopters implement more extensive programs. The data fail to reveal much internal learning, although there is evidence of some. External impacts are clear: managed care enrollments in neighboring states and changes in the federal waiver process affect states’ decisions. Other policy choices are important; states with more generous Medicaid eligibility rules implement more extensive managed care programs. Complementing other studies of Medicaid, we find that politics and economics make a difference for the extent of managed care programs; unlike other Medicaid studies, we find no effect of race and ethnicity.


Medicaid Managed Care Enrollment, Innovation, Diffusion, and Reinvention, Internal Learning, Vertical Diffusion


Public Affairs, Public Policy and Public Administration

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