One of the most significant Medicaid managed care developments in 2021 happened on December 29, when CMS approved federal funding and waivers for California’s reform initiative, Advancing Innovation in Medi-Cal (CalAIM). The approval involved two sets of waivers, one operating under section 1115 of the Social Security Act, the other under section 1915(b)(4). For good […]
The Medicaid managed care ecosystem is huge and complex. (If you need a primer, the health policy podcast Tradeoffs has a short and entertaining one). As of March of this year, forty states and the District of Columbia were contracting with over 280 different managed care organizations (MCOs). The federal government and states combined spend […]
While we were all unwinding from our Thanksgiving celebrations, CMS was busy putting out two new tools to assist state Medicaid eligibility and enrollment operations. The first is focused on preparing for the return to normal operations after the COVID-related continuous enrollment requirement is lifted while the second is a refresher on best practices and […]
The Q3 results for the “Big Five” are in. Loyal readers of the Say Ahhh! Blog will recognize them as the publicly-traded companies with the largest shares of the Medicaid managed care market: Aetna/CVS, Anthem, Centene, Molina, and UnitedHealth Group. Their Medicaid footprints for the quarter ending September 30, summarized below, reflect a continuation of […]
There’s a natural experiment underway involving a highly vulnerable population: children and youth in foster care. The experiment is a test of whether MCO/FCs outperform other ways of furnishing needed health care to this population. No, MCO/FCs are not a soccer team in the English Premier League. The initialism stands for Medicaid managed care organizations […]
Executive Summary Children and youth in foster care are among the most vulnerable populations covered by Medicaid. When children and youth enter the child welfare system, they are often not up to date on routine care, and many have unrecognized and untreated medical needs. In addition, the experience of removal from a child’s biological family, […]
