Latest From Andy
Transparency in Medicaid Managed Care: The MCPAR Saga Continues
Three years ago, the Center for Medicaid & CHIP Services (CMCS) issued an CMCS Informational Bulletin (CIB) on “Medicaid and CHIP Managed Care Monitoring and Oversight Tools.” The CIB triggered a 2016 regulatory requirement that states contracting with managed care organizations (MCOs) submit to CMCS a Managed Care Program Annual Report (MCPAR). The MCPAR contains […]
For-Profit MCOs in Minnesota Medicaid: No More Welcome Mat
Like 41 other states, Minnesota requires most of those enrolled in its Medicaid program to receive services through managed care organizations (MCOs). Unlike most other states, however, Minnesota is in the midst of a policy conversation about whether to move away from managed care toward fee-for-service. In May 2023, the state legislature directed the Medicaid […]
Medicaid Managed Care: Results of the PHE Unwinding for the Big Five in Q1 2024
It’s now been four corporate reporting quarters since the start of the PHE unwinding on April 1, 2023. During that time, net national Medicaid enrollment—the combination of disenrollments from redeterminations, re-enrollment by some of those terminated, and new enrollments—has fallen by 13.1 million, including 5.0 million children. Of the disenrollments, 70 percent have been for […]
A Closer Look at Transparency in the Medicaid Managed Care Rule
The Medicaid Managed Care Rule published on May 10 has lots of moving parts. As my colleague Leo Cuello explains, the rule includes provisions to increase the transparency of state directed payments (SDPs). The rule also contains a number of other transparency requirements that are the focus of this blog, most of which are identical to those […]
A Closer Look at the Access Provisions in Final Medicaid Managed Care Rule
As my colleague Leo Cuello has explained, the Centers for Medicare & Medicaid Services (CMS) has revised its regulations governing Medicaid managed care. One purpose of this new Managed Care Rule is to improve access to health care for children, families, and other populations enrolled in Medicaid managed care organizations (MCOs). This blog takes a […]