Medicaid Managed Care Market Tracker
More than half of all Medicaid beneficiaries nationally receive most or all of their care from risk-based managed care organizations (MCOs) that contract with state Medicaid programs to deliver comprehensive Medicaid services to enrollees. Although not all state Medicaid programs contract with MCOs, a large and growing majority do, and states are also rapidly expanding their use of MCOs to reach larger geographic areas, serve more medically complex beneficiaries, deliver long-term services and supports, and, in states that have expanded Medicaid under the Affordable Care Act (ACA), to serve millions of newly eligible low-income adults.
To enhance understanding and analysis of the Medicaid managed care market, the Medicaid Managed Care Market Tracker provides state-level, MCO-level, and parent firm-level information related to comprehensive Medicaid MCOs. (Information related to prepaid ambulatory health plans (PAHP), prepaid inpatient health plans (PIHP), and Programs of All-Inclusive Care for the Elderly (PACE), and data on enrollment in MCOs through states’ capitated financial alignment demonstrations for beneficiaries dually eligible for Medicare and Medicaid, are not included in this Tracker.) To shed light on broader market dynamics, the Tracker also provides data on parent firm participation in other health insurance market sectors. The Medicaid MCO enrollment data included in this Tracker were obtained from managed care enrollment reports posted on state Medicaid websites or, in some cases, provided to us by state Medicaid officials. Not all states with Medicaid MCOs currently post this information; as additional states make their MCO enrollment data available, we will add these data to the Tracker.
Medicaid Managed Care State-Level Data
- Total Medicaid MCOs
- Total Medicaid MCO Enrollment
- Annual Change in Total Medicaid MCO Enrollment
- Share of Medicaid Population Covered under Different Delivery Systems
- Medicaid Managed Care Penetration Rates by Eligibility Group
- Total Medicaid MCO Spending
- Medicaid MCO Access Standards: Primary Care
- Medicaid MCO Access Standards: Specialty Care
- Total Medicaid Enrollment in Managed Long-Term Services and Supports (MLTSS)
- Medicaid Managed Care Expansion Activity
- Medicaid Managed Care Quality Initiatives
Medicaid MCO-Level Data
Parent Firm-Level Data
about this data collection
This Data Collection, the Medicaid Managed Care Market Tracker, provides information related to risk-based Medicaid managed care organizations (MCOs) that provide comprehensive services, including acute care services and, in some cases, long-term services and supports as well, to Medicaid enrollees. In addition, the Tracker provides information on parent firms that own Medicaid MCOs in two or more states. Data on other forms of Medicaid managed care, including prepaid ambulatory health plans (PAHPs), prepaid inpatient health plans (PIHPs), primary care case management (PCCM), and Programs of All-Inclusive Care for the Elderly (PACE) are not included in this Data Collection. For more information on those managed care programs, please see other Medicaid Managed Care data on State Health Facts.
The data in this Tracker derive from numerous sources, including reports and other information available on the websites of state Medicaid agencies, MCOs, and parent firms; reports issued by the Centers for Medicare & Medicaid Services (CMS); proprietary data (by permission); and other sources. Additional detail on the sources for each indicator is provided below:
Medicaid Managed Care State-Level Data
- Total Medicaid MCOs: Websites of state Medicaid agencies and Medicaid MCOs.
- Total Medicaid MCO Enrollment: Medicaid managed care enrollment reports posted on state Medicaid agency websites or provided by state Medicaid officials. Note: States may count and report total Medicaid MCO enrollment in different ways. For example, some states’ total MCO enrollment may include CHIP enrollees as well as Medicaid enrollees.
- Change in Total Medicaid MCO Enrollment:Medicaid managed care enrollment reports posted on state Medicaid agency websites or provided by state Medicaid officials. Note: States may count and report total Medicaid MCO enrollment in different ways. For example, some states’ total MCO enrollment may include CHIP enrollees as well as Medicaid enrollees.
- Share of Medicaid Population Covered under Different Delivery Systems, Medicaid Managed Care Penetration Rates by Eligibility Group: Implementing Coverage and Payment Initiatives: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2016 and 2017, Kaiser Family Foundation, October 2016.
- Total Medicaid MCO Spending: CMS-64.
- Medicaid MCO Access Standards (Primary Care and Specialty Care): State Standards for Access to Care in Medicaid Managed Care, Office of Inspector General, U.S. Department of Health and Human Services, September 2014.
- Total Medicaid Enrollment in Managed Long-Term Services and Supports (MLTSS): The Growth of Managed Long-Term Services and Supports (MLTSS) Programs: A 2012 Update, CMS.
- Medicaid Managed Care Expansion Activity, Medicaid Managed Care Quality Initiatives, and Minimum Medical Loss Ratio (MLR) Policies for MCOs: Implementing Coverage and Payment Initiatives: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2016 and 2017, Kaiser Family Foundation, October 2016.
Medicaid MCO-Level Data
- Medicaid MCO Enrollment: Medicaid managed care enrollment reports available on state Medicaid websites or provided by state Medicaid officials.
- Medicaid MCO Quality Rankings: NCQA Health Insurance Plan Ratings 2015-2016 – Summary Report (Medicaid).
- Medicaid MCOs and their Parent Firms:Websites of state Medicaid programs, Medicaid MCOs, and parent firms.
Parent Firm-Level Data
- Medicaid MCO Parent Firm Activity, by State and Insurance Market: Websites of Medicaid MCOs and parent firms (Medicaid MCO Market); Kaiser Family Foundation analysis of QHP Landscape Individual Market Medical files for plans available through the federally-facilitated Marketplace, and of state insurance filings for plans participating in state-based Marketplaces (QHP Marketplaces); and Kaiser Family Foundation analysis of MA Landscape Source Files, available at https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/.
- Medicaid MCO For-Profit Parent Firm Financial Information: Parent firm websites and Fortune 500.
The data in the Medicaid Managed Care Tracker are current to the date or period specified in the sources for each table.
The information in this Tracker is public information and may be reproduced with appropriate citation.
