Latest From Andy
Transparency in Medicaid Managed Care: CMS Posts Annual MLR Reports
On November 1, CMS posted on its website Medical Loss Ratios (MLRs) for individual Medicaid managed care organizations (MCOs) in 2018, 2019, and 2020. These data come from the MLR Summary Reports that states are required to submit to CMS. This CMS action follows the posting on July 15 of the first tranche of Managed […]
Medicaid Managed Care: Results of the PHE Unwinding for the Big Five in Q3 2024
Another quarter, another round of earnings reports from the “Big Five.” The story of Q3 continues the basic narrative of Q1 and Q2. For all but one of the companies that dominate the Medicaid managed care market, net Medicaid enrollment continued to decline, driven primarily by the PHE unwinding. There is one new wrinkle, however. […]
Medicaid Managed Care: Results of the PHE Unwinding for the Big Five in Q2 2024
The Q2 2024 earnings reports for the “Big Five” Medicaid managed care companies are in. They tell us that the PHE unwinding is winding down, but it’s still driving declines in Medicaid enrollment for the companies as a group. Here are the numbers. For the fifth consecutive quarter, beginning with Q2 2023, Medicaid enrollment for […]
An Explanation of Final Medicaid Managed Care and Access Rules
Executive Summary While the Centers for Medicare & Medicaid Services (CMS) has overseen the steady growth in Medicaid coverage over recent years, CMS has faced the additional challenges of ensuring that coverage truly leads to meaningful access to care and that there is strong oversight. CMS recently finalized two key regulations: “Ensuring Access to Medicaid […]
Transparency in Medicaid Managed Care: CMS Posts the MCPARs
There’s been a startling—but VERY welcome—development in the long-running MCPAR saga. On July 15, CMCS posted on its medicaid.gov the first three tranches of Managed Care Program Annual Reports (MCPARs) submitted by state Medicaid agencies for performance year 2023. The agency promises to post the remaining tranche for performance year 2023 in October, with quarterly […]