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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.

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  • Medicaid Managed Care: The Big Five in Q3 2025

    Q3 2025 is the first quarter of a new chapter in the Medicaid managed care narrative.  At the beginning of the quarter, H.R. 1 was enacted.  As explained by our colleagues Edwin Park and Sabrina Corlette, the new law will upend Medicaid enrollment and financing for years to come, cutting federal payments to states by…

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  • Medicaid Managed Care: The Big Five in Q2 2025

    Q2 2025, which ended on June 30, is not just another quarter.  That’s because on July 4 the Budget Reconciliation Law (P.L. 119-21) was signed into law.  That law makes major cuts to Medicaid, reducing federal payments to states by $990 billion over the next ten years and leaving 7.5 million Americans uninsured in 2034.…

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  • Where Interests Conflict: Medicaid Managed Care Meets Work Reporting Requirements

    Q2 ended on June 30, and the earnings calls have started.  The first of the “Big Five” Medicaid managed care companies out of the gate was Elevance Health.  The financial analysts on last week’s call had a number of questions relating to the Medicaid provisions of the Budget Reconciliation Law (BRL) P.L. 119-21, that create…

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  • Medicaid Managed Care: Headwinds for the Big Five in the Budget Reconciliation Law

    Early this week FitchRatings posted its take on the implications of the Budget Reconciliation Law (P.L. 119-21) for the “Big Five” insurers— Centene, CVSHealth/Aetna, Elevance Health, Molina Healthcare, and UnitedHealth Group—that together account for half of the Medicaid managed care market: U.S. health insurers managing coverage for state Medicaid programs will face revenue headwinds due…

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  • Medicaid Managed Care: Work Reporting Requirements in the One Big Beautiful Bill Act

    Centene Corporation is the nation’s largest Medicaid managed care company, with nearly 13 million Medicaid enrollees in Q1 2025.  At the company’s April 25 earnings call, a financial analyst asked Centene’s CEO about the implications of work reporting requirements for the company’s Medicaid business: AJ Rice (UBS): “…You also mentioned the work rules which does…