Regular Say Ahhh! readers know that most children covered by Medicaid in most states received their coverage through private insurance companies, or managed care organizations (MCOs).  We believe that publicly-available data on Medicaid managed care performance is key to fully understanding how well Medicaid MCOs are working for children. Consistent, MCO-level data helps identify gaps in care for improvement and helps states identify the best policy tools to drive needed improvement.

To that end, this week we are pleased to release a new paper in our Medicaid managed care series,  Medicaid Managed Care and Early Childhood Development: A 12-state Scan. We set out to determine whether state Medicaid managed care programmatic and performance data were publicly available and useful to better understand the role of Medicaid MCOs serving young children in 12 states. Are policymakers, enrollees, advocates and the public able to assess how Medicaid is performing for young children in these states based on state agency website data and reports? In short, no.

Table 1 summarizes the results of our scan. Among the 12 states we reviewed:

• Three state agencies posted MCO-specific enrollment data for young children; only one state (Ohio) provided additional stratification by race/ethnicity.
• One state agency (Ohio) posted Medicaid payments to MCOs for young children.
• Only Kansas posted data on the individual performance of MCOs in delivering the Medicaid pediatric benefit (EPSDT).
• The Child Core Set includes five measures specific to early childhood. None of the 12 states posted all five measures by MCO. Seven of the 12 states posted at least three of the five early childhood measures by MCO. Louisiana posted MCO-level Child Core Set measures stratified by race/ethnicity and rurality.
• Only four of the 12 states posted MCO-level measures for young children on a child health dashboard.
• Six states posted consumer-facing MCO report cards that included measures specific to young children.
• None of the Fetal-Infant or Child Death Review reports in the 12 states included data related to individual Medicaid MCOs.

Our full paper and its appendices provide additional background and detail on each of the areas reviewed.

Kelly Whitener’s blog post last week reviewed findings from CCF’s focus groups with families and providers, which underscore the critical role MCOs play in making sure children can get the right care at the right time–care they are entitled to receive under Medicaid’s pediatric benefit, EPSDT. A recent ProPublica article shows in more stark terms the role a single MCO can play in preventing children with autism from getting needed care. The recent managed care and access regulations and EPSDT guidance align with the opportunity for states to do more in this area.

Our new report also offers recommendations to policymakers and state advocates to improve availability of MCO-level performance data. But the big question now is–what will the new Administration and Congress mean for MCO transparency? The proposals on the table for Congress to make dramatic cuts to Medicaid will make it much harder for state agencies to make Medicaid work for the more than 70 million Americans, including more than 30 million children, who rely on the program for coverage. But no matter what’s ahead next year, the need for more transparency and accountability in Medicaid managed care won’t disappear.

Read more about our findings in the full paper.