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.
Medicaid Managed Care Appeals and Grievances: GAO Takes a Look
Last week, GAO issued a performance audit of data on Medicaid MCO appeals and grievances. The database GAO examined was the first year of Managed Care Program Annual Reports (MCPARs) submitted by state Medicaid agencies to CMS. MCPARs are one of three reports on which CMS relies to conduct oversight of state managed care programs […]
Medicaid Managed Care: Congress Falls Short on Medical Loss Ratios
On March 9, the President signed into law the Consolidated Appropriations Act, 2024 (P.L. 118-122). Buried in the 428-page text is a 3-line provision delightfully, if somewhat obscurely, titled “Promoting Value in Medicaid Managed Care.” This is a classic in the genre of offsets, flying well under the radar to carry out its mission of […]
Medicaid Managed Care Financial Transparency: Which States Are High Performers?
As Say Ahhh! readers know, CCF researchers have scanned state Medicaid agency websites for information about the performance of individual managed care organizations (MCOs) for children, for children and youth in foster care, and, most recently, for pregnant and post-partum women. In most of the states we looked, it wasn’t possible to identify which MCOs […]
Medicaid Managed Care: Results of the PHE Unwinding for the Big Five in Q4 2023
Q4 2023 was also the third quarter of the PHE “unwinding”—the redetermination of eligibility for all 86.7 million Medicaid enrollees following the expiration of the Public Health Emergency continuous coverage provision in March 2023. These redeterminations have resulted in the disenrollment of over 16 million Medicaid enrollees as of January 2024, which translates into a […]
Minnesota Medicaid Revisits the Question: Managed Care or Fee-for-Service?
In the beginning, there was fee-for-service (FFS). In this case, the beginning was 1965, when Medicaid (and Medicare) were enacted. FFS was the way that these public programs, as well as almost all private insurers, purchased health care. Fast forward to today. Propelled by an interest in budget predictability and federal policy changes giving them […]
It’s Unanimous: CMS Needs to Bring More Transparency to Medicaid Managed Care
Last week, MACPAC Commissioners voted to recommend that the Centers for Medicare & Medicaid Services post all state Managed Care Program Annual Reports (MCPARs) to the CMS website. The vote was unanimous: 17-0. The recommendation will be included in MACPAC’s March 2024 Report to Congress. At first glance, this may seem unremarkable, but on further […]