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Managed Care

Managed care is the primary Medicaid delivery system in more than half the states. States have incorporated managed care into their Medicaid programs for a number of reasons, including:

  • Managed care provides states with some control and predictability over future costs.
  • Compared with fee for service, managed care can allow for greater accountability for outcomes and can better support systematic efforts to measure, report, and monitor performance, access, and quality.
  • Managed care programs may provide an opportunity for improved care management and care coordination.

Close to half of federal and state Medicaid spending in fiscal year 2017 (over $283 billion) was on managed care. The proportion continues to grow each year. As of 2016, over 90 percent of Medicaid beneficiaries were enrolled in some form of managed care, up from about 56 percent in 2000. MACPAC annually compiles updated information on managed care spending and enrollment.

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Featured Publications

Denials and Appeals in Medicaid Managed Care

March 15, 2024

Chapter 2 looks at the monitoring and oversight of denials and appeals in Medicaid managed care and the beneficiary experience with the appeals process. Beneficiaries appeal few denials, and program operators do not collect comprehensive information about denials in Medicaid managed care. Federal rules do not require states to collect and monitor data needed to […]

Improving the Managed Care Appeals Process

November 2, 2023

During this meeting session, staff presented policy options for the appeals process in Medicaid managed care.
Medicaid managed care organizations (MCOs) manage and provide care to beneficiaries enrolled in their plans. This includes authorizing and paying for covered services, as well as denying or limiting services to ensure that only appropriate, medically necessary care is provided […]

Denials and Appeals in Medicaid Managed Care

September 20, 2023

During this session, staff presented policy options for monitoring and oversight of denials and appeals in Medicaid managed care.
Medicaid managed care organizations (MCOs) manage and provide care to beneficiaries enrolled in their plans. This includes authorizing and paying for covered services, as well as denying or limiting services to ensure that only appropriate, medically necessary […]