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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.

Featured Posts

  • 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…

  • Medicaid and CHIP Rules on Chopping Block

    As my colleague Edwin Park has written, the House Budget Committee “menu” of Medicaid cuts includes rescinding regulations promulgated by the Biden Administration. Of particular interest to readers of SayAhhh!, the menu includes rescinding the Medicaid and CHIP eligibility and enrollment rule and the two companion rules on improving access to care in fee-for-service and…

  • Medicaid Managed Care: The Big Five in Q4 2024

    The “Big Five” earnings results for Q4 of 2024 are now in. The “Big Five” are the publicly-held companies that together control half of the Medicaid managed care market: Centene, CVSHealth/Aetna, Elevance Health, Molina Healthcare, and UnitedHealth Group. (There are five nonprofit Medicaid managed care organizations (MCOs) with significant regional or single-state market footprints, but…

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  • Medicaid Managed Care in 2024:  The Year That Was

    2024 was a year of transition for Medicaid managed care.  At the federal level, there were significant revisions in regulatory requirements relating to access to care and increases in transparency about MCO performance.  At the state level, the end of the unwinding of the public health emergency continuous eligibility requirement meant the end of the…

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