Empowering the Partnership Between States and Managed Care Organizations

This story is from Sellers Dorsey. Read more here. 

In the most recently published MACStats: Medicaid and CHIP Data Book, the Medicaid and CHIP Payment and Access Commission (MACPAC) estimates that enrollment in comprehensive Medicaid managed care programs reached over 57 million people in 2019, an increase of over 50% from the approximately 37 million enrollees in 2013. They also found that comprehensive managed care programs covered nearly 70% of Medicaid enrollees in 2019, compared to almost 54% in 2013.

Comprehensive managed care programs are predominantly delivered through contracts between state Medicaid programs and managed care organizations (MCOs) and cover acute care such as hospital visits, primary care such as preventive services, and a wide range of specialty services. Depending on the state, MCOs may also be responsible for providing access to and coordinating behavioral health and long-term services and supports (LTSS).

When designed and monitored effectively, comprehensive managed care programs align incentives across all participants in the system (e.g., state Medicaid program, MCOs, Medicaid members, providers) to improve health outcomes for members, reduce unnecessary spending, and achieve other state Medicaid programmatic goals.

The immense growth in the use of comprehensive managed care programs demonstrates that when it comes to delivering high-quality care for our nation’s vulnerable populations, the partnership between states and MCOs is more important than ever.

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