New Resources on Medicaid Managed Care – Say Ahhh! A Children’s Health Policy Blog

States may choose to adopt managed care in Medicaid for a
number of reasons. For example, they may be interested in improving care
management and coordination. Others may wish to gain more predictability in
spending or increase accountability for access to providers and quality of
care. No matter what the reason (or combination of reasons), more states seem
to be eyeing managed care in Medicaid. A number of new resources are
available to help them (and advocates) navigate the subject:

  • Our new favorite data source, MACPAC, released its
    second report
     to Congress in June. The report, which examines the
    evolution of managed care in Medicaid, finds that approximately 49 million
    enrollees (71%) are in some form of managed care arrangement (although most
    Medicaid enrollees still receive at least some services through fee for
    service). 60% of non-disabled children are enrolled in managed care in Medicaid
    and 75% of kids in CHIP (including those in CHIP-funded Medicaid expansions)
    are enrolled managed care. In addition to providing background information on
    managed care in Medicaid (for example payment policies), its MACStats section
    presents state-level data highlighting enrollment, service use, spending, and
    characteristics of individuals with disabilities.

  • The Commonwealth Fund released a report examining how Medicaid managed care health plans differ. Since 2004, publicly
    traded health plans have played an increasingly significant role in Medicaid
    managed care. This study found that publicly traded plans with primarily a
    Medicaid focus, paid out the lowest percentage of their revenues in medical
    expenses. Additionally, they reported the highest percentage in administrative
    expenses. Publicly traded plans also received lower scores for quality-of-care
    measures related to preventive care, treatment of chronic conditions, access to
    care, and customer service. All important issues to keep in mind when
    considering whom to contract with.

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