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Johnston, J. M. and B. S. Romzek (1999). 'Contracting and accountability in state medicaid reform: Rhetoric, theories, and reality'. Public Administration Review 59(5): 383.
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Medicaid reform represents conceptual and implementation challenges for practitioners and scholars. One such reform, in Kansas, where the state contracted with nonprofit agencies for Medicaid case management services is investigated. Policy rationales for this social service reform in light of the actual economic and management environments are examined. A typology of contract management complexity which articulates how structural factors affect contract management challenges is offered; it indicates that this social service reform presents substantially greater complexity than more traditional service contracting. The analysis shows that key aspects of the market model of contracting are absent in this reform, reflecting a gap between the political rhetoric which surrounds the reform and the reality of the contracting experience. The lack of market conditions to impose discipline on contractors raises questions about contract management capacity and administrative accountability.