Medicaid/CHIP Managed Care Regulations: Ensuring Accountability and Transparency

In May 2016, the Centers for Medicare & Medicaid Services (CMS) completed its modernization of the regulations governing managed care in Medicaid and the Children’s Health Insurance Program (CHIP). One of CMS’ primary goals in this regulatory overhaul is to promote transparency, enabling policy makers, beneficiaries, providers, and other stakeholders to better understand and monitor Medicaid and CHIP managed care programs. The revised regulations are also intended to strengthen program integrity standards to ensure that public funds are being used appropriately.

In this issue brief, we discuss the major provisions designed to promote transparency and accountability: general contracting requirements, actuarial soundness and rate setting, Medical Loss Ratios (MLR), and website posting requirements.

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

Kelly Whitener is an Associate Professor of the Practice at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.