Medicaid

This brief provides an overview of how Medicaid managed care organization (MCO) capitation rates are developed and approved, highlights options available to states to adjust current rates and/or risk sharing mechanisms, describes how MCOs pay providers, and outlines state options to direct MCO payments to providers in response to conditions created by the COVID-19 pandemic.

Following a successful ballot measure on Aug. 4, Missouri became the 38th state (plus D.C.) to adopt the Affordable Care Act’s Medicaid expansion. The approved measure adds Medicaid expansion to the state’s constitution. Missouri is the second state to expand Medicaid during the coronavirus pandemic, after a ballot measure passed in Oklahoma in June. Twelve states have not adopted expansion.

This analysis examines trends related to cases and deaths in long-term care facilities due to COVID-19, including state-level cumulative data, weekly trends, and national comparisons.

Millions of Americans rely on Medicaid drug coverage both for treating acute problems and for managing ongoing chronic or disabling conditions. Though optional, all states provide pharmacy benefit coverage in Medicaid and administer the benefit in different ways within federal guidelines. Our state fact sheets offer a snapshot of the administration and delivery of Medicaid pharmacy benefits in each state. They are based on data from a survey of states conducted between June and December 2019.

Most (62%) of the 22 million adults with Medicaid coverage in the U.S. who are not eligible for both Medicare and Medicaid, and who do not receive federal disability payments, are already working full- or part-time. We highlight data related to the work status and financial security of Medicaid adults prior to the coronavirus pandemic as well as findings from focus groups conducted with Medicaid enrollees in January 2020.