California’s Medicaid Managed Care Procurement: A Transparency Event

On August 25, California’s Medicaid agency announced its selections of managed care organizations (MCOs) to serve some 6.4 million beneficiaries in 21 counties beginning in 2024.  The selections, which resulted from the procurement that the agency launched with a Request for Proposal (RFP) in February—a potential game-changer—did not meet with universal applause.  Losing bidders have […]

Andy Schneider

Medicaid Managed Care: OIG, MLRs, and the Future of Oversight

Last month, the Office of Inspector General (OIG) issued a report that speaks volumes about the oversight of Medicaid managed care organizations (MCOs).  As the OIG delicately puts it, CMS has “opportunities” to “strengthen States’ oversight.”  An alternative framing would be that CMS and many states have not met minimum standards of stewardship for Medicaid […]

Andy Schneider

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 […]

Hannah Klukoff

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 […]

Andy Schneider
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