A new issue brief highlights key facts about states’ use of managed care in Medicaid, including data and trends related to enrollment, state spending, and market share. Plus, new data available on KFF’s Medicaid Managed Care Market Tracker illustrates the substantial role private insurers now play in the program.

This brief describes key themes related to the use of comprehensive, risk-based managed care in the Medicaid program and highlights data and trends related to MCO enrollment, service carve-ins, spending, MCO parent firms, and state and plan activity related to quality, value-based payments, and the social determinants of health.

Medicaid funds typically cannot be used to pay for non-medical interventions that target the social determinants of health. However, in October 2018, CMS approved North Carolina’s Section 1115 waiver which provides financing for a new pilot program, called “Healthy Opportunities Pilots,” to cover evidence-based non-medical services that address specific social needs linked to health/health outcomes. The pilots will address housing instability, transportation insecurity, food insecurity, and interpersonal violence and toxic stress for a limited number of high-need Medicaid enrollees. This brief summarizes key features of the pilots.

On November 14, 2018, the Centers for Medicare and Medicaid Services (CMS) proposed revisions to the Medicaid managed care regulations with public comments due by January 14, 2019. CMS previously finalized a major revision to these regulations in 2016. The November 2018 proposed rule is not a wholesale revision of the 2016 final rule but proposes changes in the following key areas: network adequacy, beneficiary protections, quality oversight, and rate setting and payment.

This report provides an in-depth examination of the changes taking place in Medicaid programs across the country. Report findings are drawn from the annual budget survey of Medicaid officials in all 50 states and the District of Columbia. This report examines the reforms, policy changes, and initiatives that occurred in FY 2018 and those adopted for implementation for FY 2019 (which began for most states on July 1, 2018). Key areas covered include changes in eligibility, managed care and delivery system reforms, long-term services and supports, provider payment rates and taxes, covered benefits, and pharmacy and opioid strategies.

For the first time in a decade, states are reporting no overall growth in Medicaid enrollment last year and expecting minimal growth this year amid a stronger economy, a new Kaiser Family Foundation survey finds. The 18th annual 50-state survey of Medicaid directors reveals that enrollment was flat in state…

Research demonstrates that improving population health and achieving health equity will require broad approaches that address social, economic, and environmental factors that influence health. This brief provides an overview of the broad factors that influence health and describes efforts to address them, including initiatives within Medicaid.

Managed care organizations (MCOs) cover nearly two-thirds of all Medicaid beneficiaries nationwide, making managed care the nation’s dominant delivery system for Medicaid enrollees. As the entities responsible for providing comprehensive Medicaid benefits to enrollees by contracting with providers, managed care plans play a critical role in shaping access to care for Medicaid enrollees. Many plan actions are dictated by state policy or contracting requirements; however, plans also have some flexibility to design payment and delivery systems and structure enrollees’ experiences using their coverage. To understand how Medicaid managed care plans approach access to care and the challenges they face in ensuring such access, the Kaiser Family Foundation conducted a survey of plans in 2017.

This interactive provides state-by-state data on Medicaid delivery system and payment reform initiatives. Users can track state Medicaid managed care, patient-centered medical home (PCMH), Health Home, Accountable Care Organization (ACO), and Delivery System Reform Incentive Payment (DSRIP) waiver activity.

This report provides an in-depth examination of the changes taking place in Medicaid programs across the country. Report findings are drawn from the annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Family Foundation (KFF) and Health Management Associates (HMA), in collaboration with the National Association of Medicaid Directors (NAMD). This report examines the reforms, policy changes, and initiatives that occurred in FY 2017 and those adopted for implementation for FY 2018 (which began for most states on July 1, 2017). Key areas covered include changes in eligibility and enrollment, managed care and delivery system reforms, long-term services and supports, provider payment rates and taxes, covered benefits (including prescription drug policies), and opioid harm reduction strategies.