Within Medicaid managed care, states use different types of arrangements to deliver services to enrollees. These arrangements differ in design, operation, and benefits covered, and measures of Medicaid managed care enrollment also vary, depending on which models are included in Centers for Medicare & Medicaid Services enrollment numbers.
States are increasingly relying on comprehensive risk-based managed care. However, many states with comprehensive risk-based plans also have primary care case management (PCCM) programs within the state, particularly in rural areas where attracting and retaining comprehensive risk-based plans or gaining provider support for managed care can be difficult. In 2009 over 30 states operated PCCM programs and eight states had more than 50 percent of their enrollment in PCCM arrangements. Section C of MACPAC’s June 2011 report describes the distinctions between various Medicaid managed care models and their use by states.
Publication Type: Reports to Congress