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This brief provides an overview of how Medicaid managed care organization (MCO) capitation rates are developed by states and approved by CMS, highlights options available to states to adjust current rates and/or risk sharing mechanisms, describes how MCOs pay providers, and outlines state options to direct MCO payments to providers in response to conditions created by the COVID-19 pandemic.
This brief takes a closer look at the five largest publicly traded companies (also referred to as “parent” firms) operating Medicaid MCOs, which account for half of Medicaid MCO enrollment nationally. This analysis presents the latest enrollment and financial data (through the end of 2023) as well as key takeaways from the firms’ unwinding experience.
A Review of the Waiver Applications, Letters of Approval and Special Terms and Conditions This background paper provides a summary of the key features of the Medicaid 1115 waivers that have been approved, proposed, implemented and conditionally rejected. This July version updates Medicaid 1115 Demonstration Waivers: Approved and Proposed Activities as of February 1995, as well as policy briefs on Medicaid waivers released in August and November of 1994. Report: Statewide Medicaid Managed Care Demonstrations…
This is an update of an earlier report also prepared by The National Association of People with AIDS (NAPWA), with support from the Foundation. That report was the product of a 1996 meeting of people with HIV, their advocates, and researchers designed to provide information about Medicaid managed care for people with HIV. This new report updates information to reflect changes in the policy and regulatory environment since that time. Report (.pdf)
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)
One mechanism for ensuring that health insurance provides value to consumers for the premiums that they pay, or that others pay on their behalf, is to require insurers to meet a minimum “medical loss ratio” or MLR standard. The MLR is the share of premium revenues that an insurer or health plan spends on patient care and quality improvement activities, as opposed to administration and profits. In a recent 50-state survey on Medicaid managed care,…
For 15 years, KCMU and HMA have conducted annual surveys of Medicaid programs across the country. The NAMD has formally collaborated on this project since 2014. This brief provides a look back at the enrollment and spending trends as well as the multitude of policy actions taken by states across key areas: eligibility and application processes; provider rates and taxes; benefits, pharmacy and long-term care since as well as highlighting more recent data on managed…
This report, Managed Care and Low Income Populations in Florida: 1996-1998 Update, updates our 1996 case study of Florida's Medicaid managed care initiatives and their effect on low-income populations. The focus of this report is on how the program has matured and how it has affected access to care and the safety net. It is one of a series of reportsfrom the Kaiser/ Commonwealth Low-Income Coverage and Access Project. This project examines how changes in…
This issue brief provides an early snapshot into disability community perspectives on state design and implementation efforts related to the new financial alignment demonstrations for beneficiaries dually eligible for Medicare and Medicaid, with an emphasis on non-elderly beneficiaries and those who use long-term services and supports.
This report provides an in depth examination of the changes taking place in state Medicaid programs across the country. The findings in this report are drawn from the 14th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured and Health Management Associates (HMA), with the support of the National Association of Medicaid Directors. This report highlights policy changes implemented…
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