Medicaid Home Care (HCBS) in 2025
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 2025.
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Total Medicaid MCOs
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Medicaid MCO Enrollment by Plan and Parent Firm, 2024
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Individuals With Disabilities and their Experiences with Medicaid Managed Care
ReportToday, one out of every four disabled Medicaid beneficiaries receives health care through managed care. This Background Paper provides insights into how Medicaid managed care is working for individuals with disabilities, based on the findings from seven focus groups held in Florida and New Mexico. The key findings show that adults and children with disabilities feel alone in managing their health care and that important components of managed care - coordination and gatekeeping role that…
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Medicaid and Managed Care: Implications for Low-income Women
ReportThis commentary reviews Medicaid's role for low-income women and examines the implications Medicaid managed care on the delivery of health services to this vulnerable population. Today 40% of the Medicaid population, mostly poor women and their children, is enrolled in managed care. Medicaid agencies are hoping managed care will control spending and address longstanding problems with access to care. Low-income women have a number of characteristics that make them doubly vulnerable to have trouble accessing…
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Comparison of Consumer Protections in Three Health Insurance Markets: Medicare Advantage, Qualified Health Plans and Medicaid Managed Care Organizations
ReportThis report examines similarities and differences in federal consumer protection standards for Medicare Advantage (MA) plans, Qualified Health Plans (QHPs), and Medicaid Managed Care Organizations (MCOs). It focuses on rules established at the federal level, though some states have chosen to go above the federal minimums and impose additional requirements for QHPs and Medicaid MCOs.
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Long-Term Services and Supports in the Financial Alignment Demonstrations for Dual Eligible Beneficiaries
Issue BriefThis issue brief compares the treatment of LTSS in the seven approved capitated financial alignment demonstrations for dual eligible beneficiaries.
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Data Note: Medicaid Managed Care Growth and Implications of the Medicaid Expansion
Issue BriefMost states today rely heavily on risk-based managed care organizations (MCOs) to serve Medicaid beneficiaries. This Data Note discusses the current role of managed care in Medicaid and examines differences in managed care growth between states that expanded Medicaid to low-income adults under the Affordable Care Act (ACA) and states that did not expand Medicaid.
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Health Insurer Financial Performance in 2024
Issue BriefThis analysis of trends in health insurers’ financial data shows that insurers’ gross margins per enrollee dipped slightly in 2024 across four markets, remaining highest in the Medicare Advantage market, followed by the individual (non-group) market, the fully insured group (employer) market, and Medicaid managed care. The analysis also examines insurers’ medical-loss ratios across the four markets.
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Medicaid Financing: The Basics
Issue BriefMedicaid represents $1 out of every $5 spent on health care in the U.S. and is the major source of financing for states to provide health coverage and long-term services and supports for low-income residents. This brief examines key questions about Medicaid financing and how it works.