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On August 25, California’s Medicaid agency announced its selections of managed care organizations (MCOs) to serve some 6.4 million beneficiaries in 21 counties beginning in 2024.  The selections, which resulted from the procurement that the agency launched with a Request for Proposal (RFP) in February—a potential game-changer—did not meet with universal applause.  Losing bidders have…

Last month, the Office of Inspector General (OIG) issued a report that speaks volumes about the oversight of Medicaid managed care organizations (MCOs).  As the OIG delicately puts it, CMS has “opportunities” to “strengthen States’ oversight.”  An alternative framing would be that CMS and many states have not met minimum standards of stewardship for Medicaid…

As frequent (or even infrequent) readers of Say Ahhh! have heard us say, the world of Medicaid managed care is complex. But because over 70 percent of all Medicaid beneficiaries (and over 80 percent of child beneficiaries) are enrolled in a Managed Care Organization (MCO), those of us who are invested in keeping track of…

Last week the Department of Justice announced that a California managed care organization (MCO) and three providers had agreed to pay a total of $70.7 million to settle allegations that they submitted false claims to the state’s Medicaid program. Most of the payments ($68.25 million) will go to the federal government, the remaining $2.45 million…

June 30 marked the end of calendar quarter 10 of the COVID-19 Public Health Emergency (PHE), or PHE Q10. For the five national companies with the largest Medicaid managed care businesses, the past two- and one-half years have been a period of particularly robust growth. Since PHE Q1, which ended on March 31, 2020, enrollment…

If the phrase “transparency in Medicaid managed care” sounds like an oxymoron, that’s because in many states it is. Finding information on the performance of individual Medicaid managed care organizations (MCOs) for children and families and other Medicaid beneficiaries on state Medicaid agency websites can be challenging. This is more than unfortunate because in the…

2022 is a big year for Medicaid managed care procurements.  Procurements are already underway in California, Iowa, and Nebraska with awards scheduled to be announced in August. New Mexico is scheduled to launch its procurement in September, and three more states — Florida, Georgia, and Texas — are expected to issue Requests for Proposals (RFPs)…

Since we debuted the Dashboard Library, we’ve been keeping our eyes on state Medicaid agency websites and are pleased to announce that we’ve discovered quite a few more. The dashboards we’ve added to the list vary widely in content and presentation style, ranging from slides to interactive workbooks. Unfortunately, none of the dashboards that we…

March 31 marked the end of the ninth quarter of the COVID-19 Public Health Emergency (PHE). First declared by the Secretary of HHS on January 31, 2020, the PHE has subsequently been extended nine times, through July 15. As long as the PHE is in place, states qualify for an additional 6.2 percentage points on…

Discussions have begun on the possibility of enacting a scaled-down version of the Build Back Better legislation. Any agreement that includes new federal spending will also require pay-fors (a/k/a offsets) either in the form of spending reductions or tax increases, or both.  In Medicaid, responsible pay-fors—i.e., policy changes that the Congressional Budget Office will score…

There is no shortage of acronyms or initialisms in government agencies and programs and Medicaid is no exception. The Medicaid and CHIP Payment and Access Commission or MACPAC (one of our favorite acronyms) devotes an entire glossary to them.  The most prominent initialism in Medicaid policy discussions these days is SDOH: social determinants of health,…

Last week, California’s Medicaid agency issued a Request for Proposals (RFP) to provide managed health care services to program beneficiaries. This is not just another Medicaid RFP. California is far and away the nation’s largest Medicaid managed care market. As of  September 2021 the state Medicaid agency contracted with 24 managed care organizations (MCOs) to…

The Q4 2021 earnings reports are in, and the five largest companies in the Medicaid managed care market—CVS Health, Anthem, Centene, Molina, and UnitedHealth Group—did very well, thank you very much. CVS Health made $17.3 billion last year; Anthem, $7.5 billion; Centene, $1.8 billion; Molina, $1.0 billion; and UnitedHealth Group $24.0 billion. Not all of…