This study examines the recent expansion of Medicaid managed
care from the perspective of the thirteen states in the Urban Institute's Assessing the New Federalism project. States are moving to managed care for Medicaid both to improve beneficiaries' access and to control the growth in program costs. However, we find that despite dramatic growth in enrollment during this decade, few states are enrolling the elderly or the disabled--the most expensive
Medicaid beneficiaries. We also conclude that cost-savings objectives are often at odds with goals of contracting with mainstream plans and protecting safety-net providers.