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  • Managed Care and Low Income Populations in Texas: 1996-1998 Update

    Report

    This report, Managed Care and Low-Income Populations in Texas: 1996-1998 Update, updates our 1996 case study of Texas' Medicaid managed care initiatives and their affect on low-income populations. The authors conclude that Medicaid managed care in Texas has had mixed results. It is one of a series of reports from the Kaiser/ Commonwealth Low-Income Coverage and Access Project. This project examines how changes in the Medicaid program have affected health insurance coverage and access to…

  • Building Strong Medicaid Managed Care Programs: A Guide To Help Consumer Advocates Participate in Strengthening HIV/AIDS Provisions in Managed Care

    Report

    This new report, prepared by NAPWA with support of the Foundation, grew out of a key recommendation in the Making Medicaid Managed Care Work report, and is designed to provide people with HIV and their advocates with the tools for understanding Medicaid managed care contracts and for working with states to make them responsive to the needs of people with living with HIV. Report (.pdf)

  • Medicaid and Managed Care

    Fact Sheet

    This fact sheet provides an overview of the Medicaid program's increasing reliance on managed care to deliver services. Fact Sheet

  • State Demonstrations to Integrate Care and Align Financing for Dual Eligible Beneficiaries: A Review of the 26 Proposals Submitted to CMS

    Report

    The Centers for Medicare and Medicaid Services (CMS) has proposed two models to align Medicare and Medicaid benefits and financing for dual eligible beneficiaries, one capitated model and one managed fee-for-service model. In the spring of 2012, 26 states submitted proposals to CMS seeking to test one or both of these models. CMS is presently reviewing the states' proposals to determine which will be implemented. This background paper examines the contents of the 26 states'…

  • The Changing Medicaid Managed Care Market

    Report

    Trends in Commercial Plans' Participation This background paper analyzes the trends in commercial plan participation in the Medicaid market by using a database specifically designed for this purpose. It examines changes from mid-1996 to mid-1997 in the types of full-risk plans serving Medicaid Beneficiaries. It also looks at trends through mid-1998 for the 15 states with the largest number of Medicaid enrollees. Background Paper: : Trends in Commercial Plans' Particpation

  • Managed Care and Low-Income Populations: A Case Study of Managed Care in California

    Report

    This report updates a 1994 case study of California's Medicaid managed care initiative. California uses three predominant managed care models in its Medi-Cal program: county organized health (COHS), geographic managed care (GMC), and the two-plan model. This case study focuses specifically on Los Angeles County's two-plan model and Orange County's COHS model. It is one of a series of reports from the Kaiser/Commonwealth Low-Income Coverage and Access Project. This project examines how changes in the…

  • What You Need to Know About Medicaid Managed Care, Amid the New Federal Rules 

    News Release

    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 payments to these organizations account for over half of total Medicaid spending. Five publicly traded firms – Centene, UnitedHealth Group, Anthem (renamed “Elevance” in 2022),…

  • The Characteristics and Roles of Medicaid-Dominated Managed Care Plans

    Report

    This policy brief (Publication #2180) provides a national profile of Medicaid-dominated managed care plans - those in which Medicaid enrollees make up at least 75 percent of total enrollment. While recent policy and market forces have encouraged the growth of these plans, basic information about them has been lacking, partly because many are not licensed as HMOs by states. As of June 1997, 118 of these Medicaid-dominated plans served 3.4 million Medicaid enrollees across the…