Medicaid/CHIP Managed Care Regulations: Enhancing the Beneficiary Experience

As managed care and particularly mandatory managed care programs have become the predominant model for delivering care in Medicaid, there has been a growing recognition of the need to provide potential enrollees with accurate and timely information about their managed care options, to enable and encourage an active choice of plans, and to ensure that automatic plan assignments are conducted thoughtfully. To this end, the modernization of federal Medicaid Managed Care regulations released in May 2016 seeks to enhance the beneficiary experience. The rules align enrollment and disenrollment processes in voluntary and mandatory managed care, and create a beneficiary support system that provides choice counseling and assistance in understanding managed care before and after enrollment in managed care. The rules also include specific requirements for supporting enrollees who use long-term services and supports through managed care (MLTSS). This brief reviews provisions of the new federal managed care rules that are intended to enhance the beneficiary experience and is the third in a series of explainer briefs, funded by a grant from the Robert Wood Johnson Foundation.

For the full series, visit our Medicaid/CHIP Managed Care page.

The video recording of our webinar on this paper is available below.

Tricia Brooks
Tricia Brooks is a Senior Fellow at the Center for Children and Families