Nonincremental Policy Change: Lessons from Michigan's Medicaid Managed Care Initiative

Studies of policy implementation have focused primarily on incremental policy change, yet policy change is sometimes implemented quickly and comprehensively. Such is the case with Michigan's recent implementation of a statewide Medicaid managed care initiative. This article analyzes Michigan's quick implementation and highlights the importance of political support, organizational change, and a supportive policy and administrative environment in affecting successful implementation. It also notes the price paid for quick implementation—namely, stakeholder dissatisfaction, mistakes, and lack of public involvement.