Medicaid Managed Care Research: 2022 in Review

As frequent (or even infrequent) readers of Say Ahhh! have heard us say, the world of Medicaid managed care is complex. But because over 70 percent of all Medicaid beneficiaries (and over 80 percent of child beneficiaries) are enrolled in a Managed Care Organization (MCO), those of us who are invested in keeping track of […]

Medicaid Managed Care Meets the False Claims Act (Again)

Last week the Department of Justice announced that a California managed care organization (MCO) and three providers had agreed to pay a total of $70.7 million to settle allegations that they submitted false claims to the state’s Medicaid program. Most of the payments ($68.25 million) will go to the federal government, the remaining $2.45 million […]

Bipartisan Safer Communities Act Provision Directs CMS to Review State EPSDT Implementation, including in Managed Care

Last month my colleague Anne Dwyer summarized the now-enacted Bipartisan Safer Communities Act and its provisions with potential to boost access to mental health services for children and families. One we will be watching closely: a review of state Medicaid EPSDT requirements, services, and practices. Long time Say Ahhh! Readers know that Medicaid’s Early Periodic […]

Transparency in Medicaid Managed Care: Are the Times A-Changin’?

If the phrase “transparency in Medicaid managed care” sounds like an oxymoron, that’s because in many states it is. Finding information on the performance of individual Medicaid managed care organizations (MCOs) for children and families and other Medicaid beneficiaries on state Medicaid agency websites can be challenging. This is more than unfortunate because in the […]

An Advocate’s Guide to Medicaid Managed Care Procurement

2022 is a big year for Medicaid managed care procurements.  Procurements are already underway in California, Iowa, and Nebraska with awards scheduled to be announced in August. New Mexico is scheduled to launch its procurement in September, and three more states — Florida, Georgia, and Texas — are expected to issue Requests for Proposals (RFPs) […]