CMS Releases Final Managed Care Rule for Medicaid, CHIP

Many children and families rely on Medicaid or CHIP as their source of health care coverage and a growing number of them are connecting with that coverage through managed care plans. How managed care is delivered has a significant impact on the health and well-being of children and families. In fact, three-quarters of children enrolled in Medicaid or CHIP receive their care through managed care plans or primary care case management programs.

We were happy to see CMS take on the task of modernizing how managed care plans operate by releasing the final rule yesterday, the first update in over a decade. This is an important step in fulfilling the state and federal governments’ joint responsibility to hold managed care organizations accountable and to ensure Medicaid and CHIP consumers get the cost-effective and high quality care they need.

CCF experts are now pouring over the final rule (all 1425 pages of it) and will share their insights once they have completed their analysis. In the meantime, here are the comments CCF submitted to the proposed rule and a blog post by Tricia Brooks on the version CMS proposed last summer. You may also find the CMS state profiles useful as they provide a detailed breakdown of Medicaid managed care program features for each state.

Cathy Hope
Cathy Hope is the Communications Director at the Center for Children and Families