States design and administer their own Medicaid programs within federal rules. Today, capitated managed care is the dominant way in which states deliver services to Medicaid enrollees. States also make decisions about which populations and services to include in managed care arrangements leading to considerable variation across states. While we can track state requirements for Medicaid managed care plans, plans have flexibility in certain areas including in setting provider payment rates and plans may also choose to offer services beyond those required in the Medicaid state plan or waivers. CMS released guidance for state Medicaid agencies outlining how managed care plans can promote continuity of coverage for individuals as states resume normal operations when the continuous coverage requirement during the public health emergency ends. Understanding these trends provides important context for the role managed care organizations (MCOs) play in the Medicaid program overall as well as during the ongoing COVID-19 public health emergency (PHE) and in its expected unwinding.
This brief describes 10 themes related to the use of comprehensive, risk-based managed care in the Medicaid program and highlights significant data and trends. With 69% of Medicaid beneficiaries enrolled in comprehensive managed care plans nationally, plans have played a key role in responding to the COVID-19 pandemic and in the fiscal implications for states.
Managed care plays a major role in the delivery of health care to Medicaid enrollees.
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