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.

Nearly half of federal and state Medicaid spending in 2014 (over $230 billion) was on managed care. The proportion continues to grow each year. As of 2014, about three-quarters (77 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

Program Integrity in Medicaid Managed Care

June 2017 |

Chapter 3 presents an in-depth examination of program integrity activities in Medicaid managed care. Traditionally, most states operated Medicaid on a fee-for-service system that enrolled and paid providers directly for discrete services. Today, however, comprehensive managed care is the primary Medicaid delivery system in over half the states, and states delegate these responsibilities to private […]
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Setting Per Capita Caps: Differences between Current Methods and Financing Proposals

March 2017 |

Congress and the new Administration are considering substantial changes to Medicaid that include replacing the current federal financing mechanism with per capita caps, which would establish per enrollee limits on federal payments to states and give states responsibility for financing spending above the fixed per capita payments. Although national per capita caps represent a major […]
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Access to Care for Children with Special Health Care Needs: The Role of Medicaid Managed Care Contracts

February 2016 |

States are increasingly enrolling children with special health care needs (CSHCN) into Medicaid managed care delivery systems. Ensuring access to care is especially important for CSHCN because they have health, developmental, and behavioral needs that exceed those of the general pediatric population. To better understand states’ Medicaid managed care access to care requirements for this […]
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