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 […]
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 […]
June 30 marked the end of calendar quarter 10 of the COVID-19 Public Health Emergency (PHE), or PHE Q10. For the five national companies with the largest Medicaid managed care businesses, the past two- and one-half years have been a period of particularly robust growth. Since PHE Q1, which ended on March 31, 2020, enrollment […]
Last month my colleague Anne Dwyer summarized the now-enacted Bipartisan Safer Communities Act and its provisions with potential to boost access to mental health services for children and families. One we will be watching closely: a review of state Medicaid EPSDT requirements, services, and practices. Long time Say Ahhh! Readers know that Medicaid’s Early Periodic […]
If the phrase “transparency in Medicaid managed care” sounds like an oxymoron, that’s because in many states it is. Finding information on the performance of individual Medicaid managed care organizations (MCOs) for children and families and other Medicaid beneficiaries on state Medicaid agency websites can be challenging. This is more than unfortunate because in the […]
Vermont is one of ten states that don’t use risk-based Medicaid managed care. It’s not that Vermont isn’t interested in risk-based managed care. The state is very interested—so long as it is the managed care organization (MCO). The state made its case to CMS in its application to extend its section 1115 demonstration beyond June […]
