Managed Care
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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…
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COVID-19, State Budget Deficits, and Medicaid Managed Care
The COVID-19 pandemic has unleashed not just death, but also massive unemployment and a steep recession. Among the economic casualties are state budgets, which have been knocked badly out of balance by the resulting drop in revenues and the prospect of increased enrollment in Medicaid and other safety net programs. Among those spared from the…
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Taxing Medicaid Managed Care to Mitigate Medicaid Cuts
In many states, Medicaid is under budgetary siege. The steep recession brought on by the COVID-19 pandemic has led to large revenue shortfalls and budget deficits, most notably an estimated $54 billion in California for the fiscal year ending June 30 and the next. States must balance their budgets, and they have only a few…
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Medicaid Managed Care in the Time of COVID-19 and State Budget Cuts
Three months into the pandemic, Medicaid’s role as the nation’s frontline health insurer has come into sharp relief. The focus is on the struggles of frontline hospitals, nursing homes, and health care workers; the vertiginous climb in the number of unemployed and uninsured; the threat to the solvency of pediatric and other primary care providers;…
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Medicaid Managed Care Transparency: A Leap Forward
The California Health Care Foundation has just issued a path-breaking report that marks an important step forward on the road to full transparency about Medicaid managed care. The report, prepared by Dr. Andrew Bindman and his colleagues at the University of California at San Francisco, examines the performance of managed care plans (MCPs) in Medi-Cal…
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Real Protections for Kids and Families in the Newest Texas Medicaid Managed Care Laws
In June 2018, the Dallas Morning News began publishing a series of in-depth investigative reports on Texans harmed through Medicaid managed care, potential conflicts of interest, and weaknesses in oversight and enforcement of Medicaid managed care contracts. The articles resulted in public hearings in the Texas House of Representatives that further explored the issues and allowed the public to comment. In…
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Medicaid Managed Care Transparency: What Can Quality Data Do?
Earlier this week the data transparency door to Medicaid managed care opened. Not as wide as some of us would hope, but wide enough to start a detailed conversation about the performance of individual MCOs on quality. It happened at a briefing sponsored by the California Health Care Foundation and took the form of a…
