Search

At the beginning of July, North Carolina became the fortieth state to make the switch from fee-for-service (FFS) to Medicaid managed care. With the new system barely off the ground, a recent news report highlighted the stories of providers facing denied prior authorizations, delayed payments, and excessive paperwork. One provider stressed that she hadn’t received…

The Medicaid managed care market continues to grow.  A review of the Q2 financial reports of the “Big Five” national managed care companies by my colleague Allie Corcoran finds that, over the first six months of 2021, Medicaid enrollment increased, on average, by 14.9 percent year-to-year. This increase is being driven in part by the…

You’ve heard it here before: for children and families in forty states and the District of Columbia, managed care organization (MCO) performance determines if they get the care to which they are entitled. And, for many MCOs, this performance is influenced by the rules, regulations, and corporate culture of their national parent firm. As of…

The Congressional Budget Office recently posted its new Medicaid baseline.  These are CBO’s spending projections for Medicaid, which it uses in scoring legislative proposals.  This FY 2021, which ends on September 30, CBO estimates that the federal government will spend $234 billion matching state spending on acute care services through managed care, more than twice…

In the world of Medicaid managed care, as Ringo might say, transparency don’t come easy. That is one take-away from a lawsuit filed earlier this week by the Better Government Association (BGA), which describes itself as “Illinois’ non-partisan full-service watchdog,” against the state’s Medicaid agency, the Department of Healthcare and Family Services (HFS), which runs…

Last month, Children Now released a report on the delivery of preventive health services to children by Medicaid managed care organizations (MCOs) in California.   The report analyzes MCO-specific performance data for 2019 for five different measures: well-child visits in the first 15 months of life; child and adolescent well-child visits; lead screening for children under…

This is the season of Medicaid policy options—especially those competing for the attention of a new Administration and a new Congress. But the federal government is not the only audience; this week a terrific report was issued to policymakers in California. Written by Jocelyn Guyer (a former CCFer), Alice Lam, and Madeleine Toups at Manatt…

The pandemic has not been good for children or their physicians. Well-child and other non-emergency visits are down, so children are missing important screening benchmarks as well as immunizations.  Pediatric practitioners who are paid on a fee-for-service basis have seen their revenues fall and the financial stability of their practices imperiled. The situation has improved…

On the way out the door, CMS Administrator Seema Verma issued changes to Medicaid managed care regulations that, among other things, weaken the standards for measuring the adequacy of managed care organization (MCO) provider networks. These changes, which will be effective December 14, were adopted over the objections of CCF and other beneficiary advocates. They…