Managed Care
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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…
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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…
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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…
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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…
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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…
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Transparency in Medicaid Managed Care: The Wait Goes On
Last month, the Centers for Medicaid & CHIP Services (CMCS) issued a Center Informational Bulletin, “Medicaid and CHIP Managed Care Monitoring and Oversight Tools.” Among other items, this CIB discusses the Managed Care Program Annual Reports that state Medicaid agencies are required to submit to CMS. MCPARs are each state’s accounting of how each of…
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Medicaid Managed Care in 2023: The Year that Was
2023 marked an inflection point in the growth of Medicaid managed care. Enrollment in MCOs, which had climbed continuously in both 2021 and 2022 due largely to the continuous coverage policy in place during the Public Health Emergency, plateaued and then headed downward, due largely to the PHE unwinding. Much uncertainty remains as to how…
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Medicaid Managed Care: Results of the PHE Unwinding for the Big Five in Q3 2023
The “Big Five” Medicaid managed care companies—Centene, CVS Health (Aetna), Elevance Health (formerly Anthem), Molina Healthcare, and UnitedHealth Group—have reported their Medicaid enrollment for the quarter ending September 30. The downward trend that began in Q2 continued for all of the companies except Molina, which experienced a small net increase (+16,000). Centene reported the largest…
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Webinar: Medicaid Managed Care Organizations and Maternal Health
View Webinar Transcript Download the Presentation Slides
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Medicaid Managed Care: Transparency of Performance on Maternal Health
Our nation is in the midst of an ongoing maternal health crisis, one that particularly affects Black women. The causes are complex, the need to address them is urgent, and there is no single solution. One of many potential solutions that has not received enough attention is Medicaid managed care. Medicaid, the nation’s largest health…
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Medicaid Managed Care, Maternal Mortality Review Committees, and Maternal Health: A 12-State Scan
Download the Full Report Introduction The United States is in the midst of an ongoing maternal mortality crisis and Medicaid, the health insurer for low-income Americans, has an important role to play in addressing it. Medicaid is the nation’s single largest maternity care insurer, paying for more than 40% of all births on average across all states,…
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How Did We Get Here? A Recent Legislative History of Medicaid Managed Care
Just over 25 years ago, Congress enacted a major change in federal policy on Medicaid managed care. It eliminated the 75/25 rule—the requirement that no more than 75 percent of the enrollees in a Medicaid managed care organization (MCO) could be Medicaid or Medicare beneficiaries. The logic of the rule was that if an MCO…
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Medicaid Managed Care: Early Results of the PHE Unwinding for the Big Five in Q2 2023
The Medicaid enrollment results for the “Big Five” during the quarter ending June 30 are now in. The Big Five have the largest share of the Medicaid managed care market: Centene, CVSHealth (Aetna), Elevance Health (formerly Anthem), Molina Healthcare, and UnitedHealth Group. They, along with two large nonprofit companies, were the focus of a recent…
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Medicaid Managed Care: Denials of Prior Authorization for Services
Kudos to the OIG! That would be the Office of the Inspector General of the Department of Health and Human Services. Although OIG is better known for its fraud-fighting persona, it also has a broader mission of making government programs work better. And with last month’s report, “High Rates of Prior Authorization Denials by Some…
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CCF Comments on Proposed Managed Care Rule
The Georgetown University Center for Children and Families submitted the following comments to HHS regarding the proposed managed care rule (“Medicaid Program; Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality; Proposed Rule-CMS-2439-P”). Comments on Managed Care Rule
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A Closer Look at the Transparency Provisions of CMS’s Proposed Medicaid Access and Managed Care Rules
Editor’s Note: Since this post was published, CCF submitted formal comments on both the Medicaid Access and Managed Care proposed rules. Transparency has long been underrated as a way of improving access to care in Medicaid. This may be about to change. Two proposed rules that CMS published on May 3 use transparency—making information about…
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Medicaid Managed Care: A New Group Arrives on the CMCS Block
There’s a new box on the Center for Medicaid & CHIP Services (CMCS) organization chart! It’s the Managed Care Group, one of (now) eight Groups within CMCS that manage the Medicaid program for the federal government. You’re probably thinking, “So what? A federal bureaucracy gets a new Group. What difference will that make for children…
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A Closer Look at the Medical Loss Ratio (MLR) Provisions of CMS’s Proposed Medicaid Managed Care Rule
Editor’s Note: Since this post was published, CCF submitted formal comments on the Managed Care proposed 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…
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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…
