The Medicaid Managed Care Policy Consensus for Welfare Recipients: A Reflection of Traditional Welfare Concerns

An Aid to Families with Dependent Children (AFDC)–Medicaid managed care policy consensus has emerged in the American states. Although there are two main organizational forms—primary care case management and risk-based capitation models—states are converging on the risk-based approach for their AFDC recipients. Risk-based Medicaid managed care for AFDC recipients assumes a distinct purpose and meaning. The reform is not just about cost control and improving access but about enduring welfare concerns: deservingness, need, and empowerment. Despite recent federal policies that have essentially severed the eligibility link between AFDC and Medicaid, state policy elites still conceive of poor families on Medicaid as a “welfare” group. Assumptions about the need for behavior modification and the need to integrate this group into “mainstream” America shape perceptions about why Medicaid managed care is appropriate for AFDC-Medicaid recipients.