Context and Overview of Medicaid Managed Care

Download Publication (pdf)

June 2011

Section A of MACPAC’s June 2011 report provides an overview of managed care in Medicaid.  Many states have pursued managed care as a tool to provide greater control and predictability over Medicaid spending, better coordinate care for enrollees, and establish provider networks for low-income enrollees. However, fee for service continues to be an important component of Medicaid program design and spending.

Managed care arrangements in Medicaid vary from those in the private sector and in Medicare due to differences in populations served, program design, and history. In particular, there are distinct differences in the role of provider networks, the use of cost sharing as a tool for managing utilization, the enrollment process, and the types of organizations sponsoring managed care plans in different markets. These differences affect whether and how states use managed care to deliver quality care.

Federal parameters guiding state use of managed care in Medicaid have evolved over time, shaping how states design their managed care delivery systems, and whom they enroll. As states and the federal government look for ways to control Medicaid spending growth, managed care is being examined as a potential vehicle for improving care and generating savings. Read more about managed care and how it functions in Medicaid.

Publication Type: Reports to Congress

From: June 2011 Report to Congress: The Evolution of Managed Care in Medicaid

Tags: CHIP, cost sharing, enrollment, full risk managed care, limited benefit plans, managed care, primary care case management