In 41 states and DC, most children covered by Medicaid are enrolled in managed care organizations (MCOs). MCOs are responsible for organizing and maintaining networks of providers that are adequate to furnish needed services to enrollees.
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Medicaid Managed Care and Early Childhood Development: A 12-state Scan
Summary and Key Findings The first five years of a child’s life are a period of rapid growth and development. During this time, frequent check-ups are essential to monitor a child’s progress so that if a problem is identified an intervention can occur before things get worse. Medicaid, a primary source of health care coverage…
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Are Children Receiving the Full Protection of Medicaid’s Pediatric Benefit Package?
Medicaid covers over 30 million children, or about 40 percent of all children. Medicaid covers disproportionately large shares of low-income children, children of color, and children with special health care needs. Medicaid law and policy necessarily impact children, oftentimes children who would be uninsured or underinsured without it. Children with Medicaid coverage are entitled to…
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Transparency in Medicaid Managed Care: CMS Posts Annual MLR Reports
On November 1, CMS posted on its website Medical Loss Ratios (MLRs) for individual Medicaid managed care organizations (MCOs) in 2018, 2019, and 2020. These data come from the MLR Summary Reports that states are required to submit to CMS. This CMS action follows the posting on July 15 of the first tranche of Managed…
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Medicaid Managed Care: Results of the PHE Unwinding for the Big Five in Q3 2024
Another quarter, another round of earnings reports from the “Big Five.” The story of Q3 continues the basic narrative of Q1 and Q2. For all but one of the companies that dominate the Medicaid managed care market, net Medicaid enrollment continued to decline, driven primarily by the PHE unwinding. There is one new wrinkle, however.…
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CMS EPSDT Guidance: MCO Monitoring and Oversight Critical, States Ultimately Responsible
We at Georgetown CCF have been poring over CMS’s new EPSDT state health official (SHO) letter. Naturally, we do have some favorite points and analysis we will continue to highlight through this series on Say Ahhh!!! Today’s topic: The importance of state agency oversight of Medicaid managed care organizations, which the SHO refers to as…