View the Latest: Managed Care
Filter
-
-
Medicaid Managed Care Plans Can Help Enrollees Maintain Coverage as the Public Health Emergency Unwinds
Issue BriefThroughout the pandemic, states have worked with managed care plans to respond to changing public health conditions and new developments. After the PHE ends, state Medicaid agencies will need to complete a large number of eligibility and enrollment tasks and actions, including processing renewals, redeterminations (based on changes in circumstance), and post-enrollment verifications. Medicaid managed care plans can assist state Medicaid agencies in communicating with enrollees, conducting outreach and assistance, and ultimately, in improving coverage…
-
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.
-
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…
-
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.
-
Analysis: At Least 37 States Have Medicaid State Directed Payments for Hospital Services That Could Be Reduced by the 2025 Reconciliation Law Limits
News ReleaseAn estimated $60 billion in federal Medicaid spending in 37 states (including the District of Columbia) would likely exceed new federal limits on state directed payments for hospital services once fully implemented, a new KFF analysis finds. States with the biggest potential reductions in Medicaid payments to hospitals include California, Illinois, Kentucky, Texas, North Carolina, Louisiana, Arizona and Michigan.
-
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…
-
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.
-
Demonstrations to Improve the Coordination of Medicare and Medicaid for Dually Eligible Beneficiaries: What Prior Experience Did Health Plans and States Have with Capitated Arrangements?
ReportThis report examines the Center for Medicare and Medicaid Services (CMS) financial alignment demonstration for beneficiaries dually eligible for Medicare and Medicaid, with a focus on the extent to which participating states and health plans have prior experience with capitated managed care arrangements under Medicare or Medicaid, and specifically for this population. Under these capitated financial alignment demonstrations, health plans contract with the state and CMS (a three-way contract) to provide both Medicare and Medicaid…
-
Key Findings on Medicaid Managed Care: Highlights from the Medicaid Managed Care Market Tracker
ReportThis report highlights 10 key findings on the Medicaid managed care market, based on analysis of data included in the Kaiser Family Foundation's Medicaid Managed Care Market Tracker. The findings provide a partial profile of the Medicaid MCO market nationally and by state. They also illuminate the involvement of large, multi-state health insurance companies in the Medicaid market and the participation of these firms in other markets as well, including the managed long-term services and…