Latest From Andy
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 […]
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 […]