Latest From Andy
An Introduction to Managed Care in CHIP
There is no excerpt because this is a protected post.
How Did We Get Here? An Early Legislative History of Medicaid Managed Care
Here is where we are today. Managed care—more precisely, comprehensive risk-based managed care—is the dominant delivery system in Medicaid. States can require beneficiaries to enroll in Medicaid managed care organizations (MCOs) in order to receive the health care services to which they are entitled, and 40 states now do so. MCOs can limit the network […]
Comments on Medicaid/CHIP Provisions in Proposed Rule on Prior Authorization
The Georgetown University Center for Children and Families submitted the following comments to CMS regarding the proposed regulation on prior authorization and interoperability. Prior Authorization Comments
Medicaid Managed Care: The President’s FY 2024 Budget
President Biden’s FY 2024 Budget includes a number of provisions relating to Medicaid and the Children’s Health Insurance Program (CHIP). Two of these would improve Medicaid managed care. One involves recovery of overpayments to managed care organizations (MCOs); the other, a new tool for enforcing MCO compliance with federal rules. Judging from the lack of […]
Medicaid Managed Care Financial Results for 2022: Another Big Year for the Big Five
The 2022 earnings reports for the “Big Five”—CVS Health (Aetna), Centene, Elevance Health (formerly Anthem), Molina, and United Health Group—are now in. As expected, combined Medicaid enrollment for the “Big Five” increased during 2022 by 3.3 million to 43.2 million, an increase of 8.2 percent (Table 1). (If children are enrolled in “Big Five” MCOs […]