How the New Medicaid/CHIP Managed Care Regulations Enhance the Beneficiary Experience

Thanks to a grant from the Robert Wood Johnson Foundation, CCF has teamed with NHeLP to launch a series of explainer briefs to unpack the new Medicaid/CHIP managed care regulations. Two briefs in the series have been released: Looking at the New Medicaid/CHIP Managed Care Regulations Through a Children’s Lens and Medicaid/CHIP Managed Care Rules: Improving Consumer Information. Today, we are releasing the third brief of the six-part series on “Improving the Beneficiary Experience.”

Why are these rules so important? First, nearly 9 out of every 10 children in Medicaid and CHIP receive health care through a managed care arrangement.

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).

We’ll be reviewing the brief and covering the beneficiary experience provisions in a webinar on Tuesday, July 19th at 1:30pm. Click here to register for the webinar.

Look for upcoming briefs in the series to include assuring network adequacy and access to services, advancing quality, and ensuring accountability and transparency. If you missed the webinar featuring the first two briefs, you’ll find the slides and a recording here.


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