Health Plan Enrollment in the Capitated Financial Alignment Demonstrations for Dual Eligible Beneficiaries
This fact sheet shows enrollment in the capitated financial alignment demonstrations for dual eligibles as of July 2017.
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Medicaid Managed Care Plans and Access to Care: Results from the Kaiser Family Foundation 2017 Survey of Medicaid Managed Care Plans
ReportManaged 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…
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Comprehensive Medicaid Managed Care Models
FeatureComprehensive Medicaid Managed Care Models in the States 2014 Download Source SOURCE: KCMU survey of Medicaid officials in 50 states and DC conducted by Health Management Associates, October 2014.
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Financial Alignment Demonstrations for Dual Eligible Beneficiaries: A Look at CMS’s Evaluation Plan
Issue BriefThis issue brief describes the Centers for Medicare and Medicaid Services’ plan to evaluate the financial alignment demonstrations, for beneficiaries dually eligible for Medicare and Medicaid via its contract with RTI International.
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Managing a High Performing Medicaid Program
ReportThis report discusses key responsibilities that the federal government and states hold for managing the Medicaid program and identifies the key issues and challenges states face as they transform the way they do business and achieve key national goals. The paper relies on an extensive review of federal and state administrative responsibilities drawn from statute, regulation, and relevant literature, coupled with discussions with six current Medicaid directors.
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A First Look at North Carolina’s Section 1115 Medicaid Waiver’s Healthy Opportunities Pilots
Issue BriefMedicaid 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…
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KFF Medicaid Managed Care Market Tracker Updated to Include Plan-Level Enrollment and Parent-Firm Data
News ReleaseA 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.
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Increasingly Privatized Public Health Insurance Programs in the US
PerspectiveIn 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.
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Strategies to Manage Unwinding Uncertainty for Medicaid Managed Care Plans: Medical Loss Ratios, Risk Corridors, and Rate Amendments
Issue BriefThis brief provides a high-level snapshot of states with minimum medical loss ratio (MLR) and remittance requirements and risk corridors in place as of July 1, 2022 that may provide financial protection and limits on financial risk for states and plans as the unwinding unfolds.
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Medicaid Arrangements to Coordinate Medicare and Medicaid for Dual-Eligible Individuals
Issue BriefThis issue brief describes how state Medicaid programs are implementing arrangements aimed at coordinating Medicare and Medicaid for dual-eligible individuals.