Managed Care
In 41 states and DC, most children covered by Medicaid are enrolled in managed care organizations (MCOs). MCOs are responsible for organizing and maintaining networks of providers that are adequate to furnish needed services to enrollees.
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. […]
CMS EPSDT Guidance: MCO Monitoring and Oversight Critical, States Ultimately Responsible
We at Georgetown CCF have been poring over CMS’s new EPSDT state health official (SHO) letter. Naturally, we do have some favorite points and analysis we will continue to highlight through this series on Say Ahhh!!! Today’s topic: The importance of state agency oversight of Medicaid managed care organizations, which the SHO refers to as […]
Webinar: MAC/BAC Webinar Miniseries
The final Managed Care and Access Rules, released in the spring, included new regulations for Medicaid Advisory Committees, which many states currently refer to as Medical Care Advisory Committees. These are groups intended to support communication and collaboration between state agencies, people enrolled in Medicaid, service providers, and other stakeholders. The new regulations broaden the scope of […]
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 […]
Improving Access in Medicaid Managed Care Using State Directed Payments
The Centers for Medicare & medicaid Services (CMS) recently released new Medicaid managed care regulations that update CMS policy on State Directed Payments (SDP). In this blog we’ll cover what SDPs are, how they can be used to improve access to care, and some changes in how CMS will allow and regulate them. You can […]
