Issue Brief
  1. PCCM is a managed fee-for-service (FFS) based system in which beneficiaries are enrolled with a primary care provider who is paid a small monthly fee to provide case management services in addition to primary care.

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  2. While MCOs are the predominant form of Medicaid managed care, millions of other beneficiaries receive at least some Medicaid services, such as behavioral health or dental care, through limited-benefit risk-based plans, known as prepaid inpatient health plans (PIHPs) and prepaid ambulatory health plans (PAHPs).

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  3. Michael Sparer, Medicaid Managed Care, (Washington, DC: Robert Wood Johnson Foundation, September 4, 2012), https://www.rwjf.org/en/library/research/2012/09/medicaid-managed-care.html

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  4. Daniel Franco Montoya, Puneet Kaur Chehal, and E. Kathleen Adams, “Medicaid Managed Care’s Effects on Costs, Access, and Quality: An Update,” Annual Review of Public Health 41:1 (2020):537-549

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  5. Total Medicaid MCO Enrollment, 2018, State Health Facts, KFF.

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  6. Up-to-date information on the status of state Medicaid expansion decisions can be found at the Interactive Map.

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  7. Federal and State Share of Medicaid Spending, FY 2019, State Health Facts, KFF.

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  8. Total Medicaid MCO Spending, FY 2019, State Health Facts, KFF.

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  9. Total Medicaid MCOs, 2018, State Health Facts, KFF.

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  10. Medicaid MCO Enrollment by Plan and Parent Firm, 2018, State Health Facts, KFF.

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  11. Medicaid MCO Parent Firm Financial Information, 2018-2019, State Health Facts, KFF.

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  12. In 2020, WellCare was acquired by Centene.

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  13. Fortune 500 Ranking, 2019, Fortune 500. Data for 2018 were published in 2019.

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  14. Medicaid Managed Care Plans and Access to Care: Results from the Kaiser Family Foundation 2017 Survey of Medicaid Managed Care Plans, 2018, KFF.

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  15. KFF survey of Medicaid officials in 50 states and DC conducted by HMA, October 2019.

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  16. Table 8 Medicaid Reforms to October 2015 Expand Coverage, Control Costs and Improve Care: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2015 and 2016

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  17. KFF survey of Medicaid officials in 50 states and DC conducted by HMA, October 2019.

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  18. Health Care Payment Learning & Action Network, Alternative Payment Model (APM) Framework, Fact Sheet; accessed at http://hcp-lan.org/workproducts/apm-factsheet.pdf. CMS launched the LAN in 2015 to encourage alignment across public and private sector payers by providing a forum for sharing best practices and developing common approaches to designing and monitoring of APMs, as well as by developing evidence on the impact of APMs.

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  19. KFF survey of Medicaid officials in 50 states and DC conducted by HMA, October 2020.

    The 11 MCO states that reported food assistance or home delivered meal initiatives are: Hawaii, Indiana, Kansas, Massachusetts, Michigan, Missouri, Nebraska, New Jersey, South Carolina, Virginia, and Wisconsin.

    The eight MCO states that reported enhanced MCO care management and outreach efforts often targeting persons at high risk for COVID-19 are: California, Colorado, Indiana, Kentucky, Missouri, Nebraska, Pennsylvania, and West Virginia.

    The four MCO states that reported provisions of PPE are: Arizona, Kansas, Kentucky, and Pennsylvania.

    The three MCO states that expanded telehealth and remote support are: Nebraska, Wisconsin, and West Virginia.

    The three MCO states that reported expanded pharmacy home deliveries are: Kansas, Nebraska, and West Virginia.

    The two MCO states that reported MCO-provided gift cards are: Kentucky and Virginia.

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.