Fact Based List:
10 Things to Know about Medicaid Managed Care
Submitted by gmccalister on Wed, 02/26/2020 - 09:40
- Today, capitated managed care is the dominant way in which states deliver services to Medicaid enrollees.
- As of July 2017, over two-thirds (69%) of all Medicaid beneficiaries received their care through comprehensive risk-based MCOs.
- Children and adults are more likely to be enrolled in MCOs than seniors or persons with disabilities; however, states are increasingly including beneficiaries with complex needs in MCOs.
- In recent years, many states have moved to carve in behavioral health services, pharmacy benefits, and long-term services and supports to MCO contracts.
- In FY 2018, payments to comprehensive risk-based MCOs accounted for the largest share of Medicaid spending.
- A number of large health insurance companies have a significant stake in the Medicaid managed care market.
- Although MCOs report challenges recruiting specialty providers, which may be linked to broader market trends, plans report a variety of strategies to recruit providers.
- Over time, the expansion of risk-based managed care in Medicaid has been accompanied by greater attention to measuring quality and outcomes.
- An increasing number of states set a target percentage of MCO provider payments that must be in alternative payment models (APMs).
- With increased attention to social determinants of health at the federal and state levels, states are looking to Medicaid MCOs to develop strategies to identify & address social determinants of health
Source: KFF
Source URL: https://www.kff.org/medicaid/issue-brief/10-things-to-know-a...
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