About 60 million Americans were enrolled in HMOs by 1996. It is estimated that 70 percent of the population under age 65 now receive some form of managed care. The rapid growth of managed care is in response to the high rising medical cost. Florida is one of twenty states implementing a Medicaid managed care demonstration program under session 1115 waivers and 1915b waivers. Medicaid enrollees are shifted from traditional fee- for-service systems to managed care systems including the most disabled and vulnerable population of individuals with chronic mental illness. Managed care may create cost-effective allocation of health resources by using different management strategies including utilization review, financial incentives, practice guidelines and protocols, and through the gatekeeping role of primary care providers. However, these management strategies also have great impact on the trusting relationship between patients and professionals. In addition, most managed care organizations contract mental health services out to behavioral health care organizations or mental health care providers. With the separation of medical care from mental health care, breakdowns in communication and discontinuity in care for this most vulnerable population is more likely. This study will examine the effect of trust on satisfaction and usage of health services among Medicaid enrollees.
