Medicaid Managed Care Regs Released – Let the Reading Begin

While we all breathed a collective sigh of relief when CMS did not release the Medicaid and CHIP Managed Care proposed rules prior to the Memorial Day weekend, we have our work cut out for us the next few weeks (months) as CMS released 653 pages of proposed rules late yesterday.  Organizations have until July 27th to submit comments.

The proposed rules mark the first major update to Medicaid and CHIP managed care regulations in more than a decade. A lot has changed during that period of time and we applaud CMS’s effort to modernize the managed care regulations.  It’s a very important issue area as approximately 70% of Medicaid beneficiaries are served through managed care delivery systems.  (To see what’s happening in your state, check out these state managed care profiles.)

CCF staff will have a lot more to say about the proposed rules in the days ahead but from a quick glance, it appears as though the regulations try to better align Medicaid and CHIP managed care rules and practices with other types of health care coverage.  For example, the rule proposes a medical loss ratio provision for Medicaid/CHIP managed care plans.  We are pleased to see that managed care consumer protections are being extended to the CHIP program.

For more information, including summaries of key provisions of the proposed rule, visit and keep an eye on Say Ahhh! as we will have more insights to share soon.