Reforming Medicaid through Contracting: The Nexus of Implementation and Organizational Culture

In: Journal of public administration research and theory, Band 9, Heft 1, S. 107-139

Abstract

Investigates the administrative experience resulting from the intersection of two popular public management trends -- social service reform & contracting out -- offering a case study of a reform in which KS contracted with nonprofit agencies to provide Medicaid case management services. Implementation of the reforms entailed substantial changes in the roles & scope of administrative activities for the agencies involved & significant challenges to the administrative cultures of each. As a result, nonprofit agencies now play a more central role in state policy deliberations & encounter higher levels of interagency political conflict than they did prior to their contracting role. While some of the rationales for the policy reform have been realized, others have been more elusive, including cost savings & the single-point-of-entry organizing principle of the reform. Implementation challenges due to turf issues, tensions over external monitoring, & differences in administrative cultures have contributed to a lack of policy subgroup cohesiveness, which could facilitate intra- & intergovernmental relationships. 1 Exhibit, 1 Appendix, 53 References. Adapted from the source document.