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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Learn More about These Topics
- Managed care’s effect on outcomes
- Monitoring managed care access
- Medicaid managed care payment
- Data for program accountability and policy development
- Enrollment and spending on Medicaid managed care
- Managed care program integrity
- Key federal program accountability requirements in Medicaid managed care
- Types of managed care arrangements
- Enrollment process for Medicaid managed care
- Managed care overview
Featured Publications
Managed Care External Quality Review: Project Recap and Next Steps
September 19, 2024
MACPAC is examining the managed care external quality review (EQR) process as part of its work on strengthening managed care oversight and accountability.
Continuing the Commission’s work on EQR from 2023, staff reviewed prior work on EQR and presented an update on EQR requirements in light of the final Medicaid managed care rule released on May 10, […]
Overview of Recently Published Final Rules
September 19, 2024
In this session, staff presented a summary of the provisions in four final rules that the Centers for Medicare & Medicaid Services (CMS) recently issued on eligibility and enrollment, access to care, managed care, and nursing facility staffing and payment transparency. For each rule, staff provided an overview of key requirements, highlighted how CMS responded […]
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 […]
