Managed Care

In this JAMA Forum column, KFF’s Larry Levitt examines the growing role of private insurance companies in public programs, including Medicare Advantage and Medicaid managed care, and the tradeoffs that result.

This brief examines the final CMS regulations governing prior authorization in Medicare Advantage, Marketplace, Medicaid, and other plans, how they might address some current consumer concerns, and some issues that remain.

This policy watch examines the burden of medical debt in North Carolina and the state’s new plan to leverage the Medicaid program to provide debt relief and support access to care for low- and middle-income North Carolinians.

In this column, KFF President and CEO Drew Altman explores the state of consumer protections in health care and explains why, even with consumer frustration clear, Congress is unlikely to pursue major new health insurance protections but there could be some modest steps.

Managed care is the most common delivery system for Medicaid. Most states (42, including DC) use comprehensive managed care plans to provide care to at least some of their Medicaid enrollees, according to KFF’s updated explainer.  Roughly 3 out of 4 Medicaid enrollees receive care through managed care organizations and…

Medicaid programs are a major source of coverage for people of color and a potential mechanism to address racial health disparities. This issue brief provides insight into ways Medicaid can mitigate racial health disparities, how coverage may vary by race and ethnicity, and other Medicaid initiatives states pursuing to address racial disparities in health and health care.

This issue brief provides an overview of what Medicaid home care (also known as “home- and community-based services” or HCBS) is, who is covered, and what services were available in 2024.

This report provides an in-depth examination of the changes taking place in Medicaid programs across the country. The findings are drawn from the 19th 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 highlights certain policies in place in state Medicaid programs in FY 2019 and policy changes implemented or planned for FY 2020.

The Centers for Medicare and Medicaid Services (CMS) continues to promote state adoption of work and reporting requirements as a condition of Medicaid eligibility for certain nonelderly adults, although several such waivers have been set aside by federal courts. While most Medicaid adults are already working, some states and health plans have developed voluntary work support programs for nonelderly adults who qualify for Medicaid through non-disability pathways. These programs offer services that support work without conditioning Medicaid eligibility on having a job. This brief examines opportunities for and limitations on federal and state support of such programs, highlights several state and health plan initiatives, and explores their common themes.

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.