10 Things to Know about Medicaid Managed Care

  1. Today
  2. capitated managed care is the dominant way in which states deliver services to Medicaid enrollees.
  3. As of July 2017
  4. over two-thirds (69%) of all Medicaid beneficiaries received their care through comprehensive risk-based MCOs.
  5. Children and adults are more likely to be enrolled in MCOs than seniors or persons with disabilities; however
  6. states are increasingly including beneficiaries with complex needs in MCOs.
  7. In recent years
  8. many states have moved to carve in behavioral health services
  9. pharmacy benefits
  10. and long-term services and supports to MCO contracts.
  11. In FY 2018
  12. payments to comprehensive risk-based MCOs accounted for the largest share of Medicaid spending.
  13. A number of large health insurance companies have a significant stake in the Medicaid managed care market.
  14. Although MCOs report challenges recruiting specialty providers
  15. which may be linked to broader market trends
  16. plans report a variety of strategies to recruit providers.
  17. Over time
  18. the expansion of risk-based managed care in Medicaid has been accompanied by greater attention to measuring quality and outcomes.
  19. An increasing number of states set a target percentage of MCO provider payments that must be in alternative payment models (APMs).
  20. With increased attention to social determinants of health at the federal and state levels
  21. states are looking to Medicaid MCOs to develop strategies to identify & address social determinants of health

Source: KFF - https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-manag…

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