10 Things to Know about Medicaid Managed Care



Authors: Hinton E, Rudowitz R, Stolyar L, and Singer N
Year: 2020
State: NatDoc: National Document
Website link: https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-managed-care/
Publicly Available: Yes
Billing and Reimbursement:
Certification:
Evidence Generation:
Policy: General other, Lessons learned from other states, MCO contract language and reimbursement models, National guidance especially in new policy areas
Sustainable Financing: Expand evidence base, General other, How to engage and work with Medicaid, Marketing/awareness campaigns including national, MCO or bundled payment reimbursement models
Workforce Development:

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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