A hands-on hands-off approach: governance of managed long-term care services in a context of rapid policy change

Amidst state-level budgetary pressures and growing elderly populations, many US states have adopted managed care for home-based services funded through the Medicaid program. New York State’s managed care mandate is part of a Medicaid ‘Redesign’ targeting health outcomes, cost control, and administrative efficiency, reflecting features emphasized by both governance and New Public Management frameworks, but neither adequately captures this case. Incorporating a Polanyian perspective can elucidate this market expansion and related reactions and re-regulation. Drawing from interviews with staff of service-providing agencies, this case study reveals outcomes contrary to goals: administrative complexity, containment of care, and unexpected costs.