Medicaid and Managed Care
This fact sheet provides an overview of the Medicaid program's increasing reliance on managed care to deliver services. Fact Sheet
View the Latest: Managed Care
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What You Need to Know About Medicaid Managed Care, Amid the New Federal Rules
News ReleaseManaged 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),…
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Early Insights from One Care: Massachusetts’ Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries
Issue BriefMassachusetts is among the early states to launch a 3-year capitated financial alignment demonstration to integrate payments and care for beneficiaries who are dually eligible for Medicare and Medicaid. This case study describes the early implementation of the demonstration based on a diverse group of stakeholder interviews.
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Behavioral Health Parity and Medicaid
Issue BriefThis issue brief explains how behavioral health parity applies in the Medicaid program, including the major provisions of the Centers for Medicare and Medicaid Services’ (CMS) April 10, 2015 proposed regulations, and identifies key policy issues at the intersection of behavioral health parity and Medicaid.
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Pieces of the Puzzle
ReportA new report describes the Report to Congress by the Department of Health and Human Services on consumer protection and quality assurance requirements for Medicaid managed care and discusses the differences between the original Federal rule and the revised one. Report Executive Summary
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Enabling Services: A Profile of Medicaid Managed Care Organizations
ReportThe report provides basic statistics on Medicaid managed care organizations providing enabling services - transportation, translation, education, and case management. The report also identifies the extent of variation across plans. REPORT Download
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Medicaid Benefits: California
Other PostCompleted for the National Conference of State Legislatures and the Kaiser Commission on Medicaid and the Uninsured, by Health Management Associates. Compiled from Medicaid State Plans and Amendments approved by the Centers for Medicare and Medicaid Services, and from State websites, with verification by State and Territorial Medicaid officials in March 2003.
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Native Americans and Medicaid: Coverage and Financing Issues
ReportMedicaid plays several different roles of significance to Native Americans. Through its purchase of managed care products, Medicaid is reshaping the health care delivery system for many Native Americans and other underserved low-income populations. Medicaid also assists low-income elderly and disabled Indians who are eligible for Medicare in meeting their premium and cost-sharing obligations. Finally, Medicaid offers coverage for nursing home care and other long-term care services needed by frail elderly and disabled Native Americans.…
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Beyond Cash and Counseling: The Second Generation of Individual Budget-Based Community Long-Term Care Programs for the Elderly
ReportStates are increasingly interested in the individual budget model for older Medicaid beneficiaries as a mechanism to improve responsiveness of benefits to beneficiaries’ needs and preferences and to increase their ability to remain outside or leave nursing homes. Beginning in January 2007, a new provision in the Deficit Reduction Act of 2005 (DRA) allows states to offer an individual budget option for an expanded range of home- and community-based services in their Medicaid state plans…
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Massachusetts and Washington: Financial Alignment Demonstrations for Dual Eligible Beneficiaries Compared
Fact SheetThis fact sheet examines the similarities and differences between the five-year demonstrations in Massachusetts and Washington state to integrate care and align financing for people dually eligible for Medicare and Medicaid. The states finalized memoranda of understanding (MOUs) with the Centers for Medicare and Medicaid Services in fall 2012, and the demonstrations in each state are set to begin in April 2013. Fact Sheet (.pdf)