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Mandatory HMO care for Milwaukee's poor.

Prologue: Five years ago, as a consequence of intense fiscal pressures on states and the federal government's new willingness to grant them broader flexibility in casting health policy, many states began to re-shape their Medicaid programs. The Omnibus Budget Reconciliation Act of 1981 was the first most sweeping in a continuing series of federal legislative acts that attempted to redefine the federal-state Medicaid program. This law modified the longstanding program requirement that individual Medicaid recipients have the freedom to obtain services from any qualified provider of care. In the ensuing years, more than half of the states have sought from the Health Care Financing Administration waivers from the freedom-of-choice requirement. Wisconsin is one such state. In this paper, authors Diane Rowland and Barbara Lyons look at the design and implementation of Wisconsin's effort to enroll Medicaid beneficiaries in prepaid health plans that offer patients a limited choice of provider. Wisconsin's initiat...