Managed Care
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Medicaid Managed Care for Foster Care Children and Youth: A Natural Experiment with Little Transparency
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…
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Transparency in Medicaid Managed Care for Children and Youth in Foster Care
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,…
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Transparency in Medicaid Managed Care: Findings from a 13- State Scan
Report Download the report. Appendix Online appendix tables. Blog Read the blog.
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Scan of 13 States’ Medicaid Managed Care Organizations Uncovers Need for More Transparency
At the beginning of July, North Carolina became the fortieth state to make the switch from fee-for-service (FFS) to Medicaid managed care. With the new system barely off the ground, a recent news report highlighted the stories of providers facing denied prior authorizations, delayed payments, and excessive paperwork. One provider stressed that she hadn’t received…
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Hidden in Plain Sight: A Medicaid Managed Care Pay-For
The Medicaid managed care market continues to grow. A review of the Q2 financial reports of the “Big Five” national managed care companies by my colleague Allie Corcoran finds that, over the first six months of 2021, Medicaid enrollment increased, on average, by 14.9 percent year-to-year. This increase is being driven in part by the…
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Medicaid Managed Care: 2021 Results for the “Big Five” at Q2
You’ve heard it here before: for children and families in forty states and the District of Columbia, managed care organization (MCO) performance determines if they get the care to which they are entitled. And, for many MCOs, this performance is influenced by the rules, regulations, and corporate culture of their national parent firm. As of…
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Medicaid Managed Care: Even Government Watchdogs Could be More Transparent
The Congressional Budget Office recently posted its new Medicaid baseline. These are CBO’s spending projections for Medicaid, which it uses in scoring legislative proposals. This FY 2021, which ends on September 30, CBO estimates that the federal government will spend $234 billion matching state spending on acute care services through managed care, more than twice…
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Medicaid Managed Care: Transparency Tips for Advocates
In the world of Medicaid managed care, as Ringo might say, transparency don’t come easy. That is one take-away from a lawsuit filed earlier this week by the Better Government Association (BGA), which describes itself as “Illinois’ non-partisan full-service watchdog,” against the state’s Medicaid agency, the Department of Healthcare and Family Services (HFS), which runs…
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A Guide for Child Health Advocates: Medicaid Managed Care Accountability Through Transparency
Medicaid, Managed Care, and Transparency Medicaid is the nation’s largest health insurer for children—over 35 million at last count—and pays for nearly half of the nation’s births. It offers a comprehensive pediatric benefit—Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services—for children and comprehensive maternity care for pregnant women. In most states, Medicaid agencies contract…
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Medicaid Managed Care: Transparency, Procurement, and Children’s Health
Last month, Children Now released a report on the delivery of preventive health services to children by Medicaid managed care organizations (MCOs) in California. The report analyzes MCO-specific performance data for 2019 for five different measures: well-child visits in the first 15 months of life; child and adolescent well-child visits; lead screening for children under…
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Medicaid Managed Care and Children with Disabilities: A Cautionary Tale
Loyal fans of the Say Ahhh! blog know that Medicaid is the nation’s largest health insurer for children, covering over 35 million. They also know that Medicaid does not exclude any child from coverage on the basis of a pre-existing condition; in fact, some children qualify for Medicaid because they receive Supplemental Security Income (SSI)…
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Medicaid Managed Care: 2020 Results for the “Big Five”
[View this blog for an update on Medicaid Managed Care earnings.] Corporate earnings statements for 2020 are now out. It was a very good year for the five largest health care companies in the Medicaid managed care market: Aetna/CVS Health; Anthem; Centene; Molina; and UnitedHealthcare. Each company experienced an increase in Medicaid enrollment between December…
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Improving Medicaid Managed Care for Children: What a Dashboard Could Do
This is the season of Medicaid policy options—especially those competing for the attention of a new Administration and a new Congress. But the federal government is not the only audience; this week a terrific report was issued to policymakers in California. Written by Jocelyn Guyer (a former CCFer), Alice Lam, and Madeleine Toups at Manatt…
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Medicaid Managed Care Covid-19 Advocacy Action Guide
Georgetown University CCF partnered with the American Academy of Pediatrics (AAP) to produce a Medicaid Managed Care COVID-19 Advocacy Action Guide. The guide explains how practitioners and child health advocates can work with MCOs and state policymakers to increase financial support for pediatric and primary care practices serving children and families enrolled in Medicaid. The…
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Advocacy Guide Outlines Strategies for Supporting Primary Care Practitioners in Medicaid Managed Care Networks During Pandemic
The pandemic has not been good for children or their physicians. Well-child and other non-emergency visits are down, so children are missing important screening benchmarks as well as immunizations. Pediatric practitioners who are paid on a fee-for-service basis have seen their revenues fall and the financial stability of their practices imperiled. The situation has improved…
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Medicaid Managed Care: The Case for Transparency in the Biden Administration
On the way out the door, CMS Administrator Seema Verma issued changes to Medicaid managed care regulations that, among other things, weaken the standards for measuring the adequacy of managed care organization (MCO) provider networks. These changes, which will be effective December 14, were adopted over the objections of CCF and other beneficiary advocates. They…
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Medicaid Managed Care Transparency: Advocacy Around External Quality Review Reports
As anyone who cares about children’s health knows, it is important to know how Medicaid managed care organizations (MCOs) are performing for the children enrolled in their plans. Access to quality data on a plan-specific basis is a vital part of determining which plans are doing the job well and which plans are falling short.…
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Medicaid Managed Care Procurement: Opportunity for Transparency?
In most states, the responsibility for ensuring that children enrolled in Medicaid receive needed services rests with managed care organizations (MCOs). They are stewards for millions of children and billions of Medicaid funding intended to meet children’s health care needs. Yet there is little transparency about how individual MCOs are performing for children. The logical…
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Medicaid Managed Care Companies Report Solid Earnings While States and Pediatricians Struggle
Q3 2020 closed on September 30, and publicly held companies have reported their financial performance. These reports, known as Form 10-Qs, are designed to provide investors with some transparency about the companies in which they are investing. Here’s what they tell us about how the five companies with the largest Medicaid managed care enrollments have…
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Redirecting Medicaid MCO Gains to Offset Network Provider Losses in the Time of COVID-19
2020 Q2 marked the arrival of the coronavirus pandemic, stay-at-home orders, school closures, social distancing, and a recession. Families put off going to the doctor’s office for routine, non-emergency care. Primary care physician practices and clinics that bill for each visit saw sharp drops in their revenues as patients stayed at home (pediatricians’ offices were…
