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 […]

Medicaid Managed Care:  Quality Performance, Sanctions, and Transparency in California

Three years ago, the California Health Care Foundation published a ground-breaking report on Medicaid managed care in the state.  Researchers from the University of California at San Francisco presented and analyzed data on the quality of care furnished by each Medicaid managed care organization (MCO) over the 10-year period 2009 – 2018. The researchers found that, over […]

Transparency in Medicaid Managed Care: The Power of the California Procurement Database

The Illinois Answers Project has just published a must-read piece of investigative reporting:  “Insurance Giant Failed Foster Kids with Inadequate Care.”  It raises a number of disturbing questions about the way children in foster care are being treated in the state’s Medicaid managed care program.  About the performance of a Centene subsidiary that has contracted […]

California’s Medicaid Managed Care Procurement: A Transparency Event

On August 25, California’s Medicaid agency announced its selections of managed care organizations (MCOs) to serve some 6.4 million beneficiaries in 21 counties beginning in 2024.  The selections, which resulted from the procurement that the agency launched with a Request for Proposal (RFP) in February—a potential game-changer—did not meet with universal applause.  Losing bidders have […]

Medicaid Managed Care: OIG, MLRs, and the Future of Oversight

Last month, the Office of Inspector General (OIG) issued a report that speaks volumes about the oversight of Medicaid managed care organizations (MCOs).  As the OIG delicately puts it, CMS has “opportunities” to “strengthen States’ oversight.”  An alternative framing would be that CMS and many states have not met minimum standards of stewardship for Medicaid […]