Managed Care
In 39 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.
A Closer Look at the Medical Loss Ratio (MLR) Provisions of CMS’s Proposed Medicaid Managed Care Rule
Earlier this month, CMS proposed changes to regulations that govern the operation of Medicaid managed care in 41 states. The main purpose of the proposals is to improve access to care (by, among other things, beefing up network adequacy standards), but there are other moving parts. This blog looks at the proposed changes to the […]
Medicaid Managed Care: Results for the Big Five in PHE Q13
The earnings reports for the “Big Five” for the quarter ending March 31—known here as PHE Q13—are in. The “Big Five”—CVSHealth (Aetna), Centene, Elevance Health (formerly Anthem), Molina Healthcare, and United Health Group—need no introduction, either to state Medicaid agencies or investors. Together, they had 44.2 million Medicaid enrollees as of March 31. If children […]
A Closer Look at the Network Adequacy Provisions of CMS’s Proposed Medicaid Managed Care Rule
Last week my colleague Kelly Whitener promised readers of the Say Ahhh! Blog a series of blogs on the proposed rules that CMS has published to improve access to care in Medicaid and CHIP. Promises made, promises kept. This blog is about the provisions of the proposed managed care rule relating to network adequacy. There […]
New Brief: An Introduction to Managed Care in CHIP
Some three million kids in states with separate CHIP programs are enrolled in Managed Care Organizations (MCOs). Who are those MCOs, and how are they performing for those children? Unlike Medicaid, there’s no publicly available national database that answers those questions. Our new brief attempts to fill that gap. We utilized a variety of methods, […]
Medicaid Managed Care Financial Results for 2022: Another Big Year for the Big Five
The 2022 earnings reports for the “Big Five”—CVS Health (Aetna), Centene, Elevance Health (formerly Anthem), Molina, and United Health Group—are now in. As expected, combined Medicaid enrollment for the “Big Five” increased during 2022 by 3.3 million to 43.2 million, an increase of 8.2 percent (Table 1). (If children are enrolled in “Big Five” MCOs […]
Medicaid Managed Care in 2022: The Year that Was
2022 was another year of growth in Medicaid managed care. Growth in enrollment. Growth in spending. There was even a modest—but most welcome—growth in transparency about the performance of Medicaid managed care organizations (MCOs) from 2021. Here are some of the top-line developments at the national and state level. The MCO Industry As of March […]