10 Things to Know about Medicaid Managed Care
Issue Brief
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.
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).
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
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
Total Medicaid MCO Enrollment, 2018, State Health Facts, KFF.
Up-to-date information on the status of state Medicaid expansion decisions can be found at the Interactive Map.
Federal and State Share of Medicaid Spending, FY 2019, State Health Facts, KFF.
Total Medicaid MCO Spending, FY 2019, State Health Facts, KFF.
Total Medicaid MCOs, 2018, State Health Facts, KFF.
Medicaid MCO Enrollment by Plan and Parent Firm, 2018, State Health Facts, KFF.
Medicaid MCO Parent Firm Financial Information, 2018-2019, State Health Facts, KFF.
- In 2020, WellCare was acquired by Centene.
Fortune 500 Ranking, 2019, Fortune 500. Data for 2018 were published in 2019.
KFF survey of Medicaid officials in 50 states and DC conducted by HMA, October 2019.
KFF survey of Medicaid officials in 50 states and DC conducted by HMA, October 2019.
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.
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.