Editor’s Note: Since this post was published, CCF submitted formal comments on the Managed Care proposed rule. Last week my colleague Kelly Whitener promised readers of the Say Ahhh! Blog a series of blogs on the proposed rules that CMS has published to improve access to care in Medicaid and CHIP. Promises made, promises kept. […]
Some three million kids in states with separate CHIP programs are enrolled in Managed Care Organizations (MCOs). Who are those MCOs, and how are they performing for those children? Unlike Medicaid, there’s no publicly available national database that answers those questions. Our new brief attempts to fill that gap. We utilized a variety of methods, […]
DOWNLOAD THIS REPORT Introduction The Children’s Health Insurance Program (CHIP) was enacted 25 years ago. [1] Today it provides coverage for children whose family incomes are too high to allow them to qualify for Medicaid but too low to enable them to afford private health insurance coverage. Together, CHIP and Medicaid insure over half [2] […]
Here is where we are today. Managed care—more precisely, comprehensive risk-based managed care—is the dominant delivery system in Medicaid. States can require beneficiaries to enroll in Medicaid managed care organizations (MCOs) in order to receive the health care services to which they are entitled, and 40 states now do so. MCOs can limit the network […]
President Biden’s FY 2024 Budget includes a number of provisions relating to Medicaid and the Children’s Health Insurance Program (CHIP). Two of these would improve Medicaid managed care. One involves recovery of overpayments to managed care organizations (MCOs); the other, a new tool for enforcing MCO compliance with federal rules. Judging from the lack of […]
The 2022 earnings reports for the “Big Five”—CVS Health (Aetna), Centene, Elevance Health (formerly Anthem), Molina, and United Health Group—are now in. As expected, combined Medicaid enrollment for the “Big Five” increased during 2022 by 3.3 million to 43.2 million, an increase of 8.2 percent (Table 1). (If children are enrolled in “Big Five” MCOs […]
