The purpose of this report is to describe the development and implementation (to date) in Minnesota of a model for rural county government participation in Medicaid managed care initiatives. This model is of interest to health policymakers because it provides an opportunity for rural communities to shape and control Medicaid managed care initiatives at the local level. The Minnesota model – called County-Based Purchasing (CBP) – allows county governments the option of functioning as direct purchasers of health care for the Medicaid beneficiaries in their area, accepting financial risk for service delivery. The main reasons that county governments have chosen to pursue CBP are a belief that care coordination is best done locally, a desire to protect the local health care infrastructure, and the fear of cost-shifting from managed care plans to counties.
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