10 Things to Know about Medicaid Managed Care

Authors: Elizabeth Hinton, Robin Rudowitz, Lina Stolyar, Natalie Singer
Year: 2020
State: CA
Website link: https://nachw.org/wp-content/uploads/2023/02/10-Things-to-Know-about-Medicaid-Managed-Care-_-KFF.pdf
Publicly Available: Yes
Sustainable Financing: CMS and CDC engagement from a national level, How to engage and work with Medicaid, MCO or bundled payment reimbursement models, National-level guidance

Managed care plays a key role in the delivery of health care to Medicaid enrollees. With 69% of Medicaid beneficiaries enrolled in comprehensive managed care plans nationally, plans play a critical role in responding to the COVID-19 pandemic and in the fiscal implications for states. This brief describes 10 key themes related to the use of comprehensive, risk-based managed care in the Medicaid program and highlights data and trends related to MCO enrollment, the development of actuarial sound MCO capitation payments, service carve-ins, total state and federal spending on MCOs, MCO parent firms, enrollee access to care, and state and plan activity related to quality, value-based payments, and the social determinants of health. Understanding these trends provides important context for the role MCOs play in the Medicaid program overall as well as during the current COVID-19 public health emergency and related economic downturn.

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