Managed Care Organizations

Medicaid final rules improve care access for managed care, FFS beneficiaries

April 23, 2024 - CMS has finalized policies to improve access to Medicaid and the Children’s Health Insurance Program (CHIP) managed care and boost coverage quality. The Medicaid and Children’s Health Insurance Program Managed Care Access, Finance, and Quality Final Rule and the Ensuring Access to Medicaid Services Final Rule address state payments,...

Read More


More Articles

Quality Outcomes Are Better When Medicaid MCOs Administer Pharmacy Benefits

by Victoria Bailey

Pharmacy-related quality outcomes were better in states where Medicaid managed care organizations administered health plans’ pharmacy benefits, according to a report from Elevance Health. The...

7 Elements of Successful Community Health Worker Integration

by Kelsey Waddill

Medicaid programs are leveraging community health workers (CHWs) to improve patient navigation, quality of care, and cultural competency, a Manatt Health newsletter found. “The use of CHWs...

3 Steps One Medicaid MCO Took to Boost Its Patient Experience Score

by Kelsey Waddill

Ease and efficiency in access to care contribute to the patient experience measurement in the National Committee on Quality Assurance’s (NCQA) Health Plan Report Card for Medicaid managed care...

Demystifying Medicaid Managed Care, Its Role in the Future of VBC

by Kelsey Waddill

As the US healthcare system slowly transitions to value-based care, Medicaid managed care organizations are joining the movement by promoting capitated payment models and quality-based assessments. California was the first state to test...

Does Medicaid Managed Care Impact Specialty Care Access for Kids?

by Victoria Bailey

Medicaid managed care enrollment was not associated with poorer specialty care access for children with special healthcare needs, but it was tied to greater caregiver frustration and reduced mental...

OIG Strengthens Oversight Strategy for Managed Care Organizations

by Kelsey Waddill

Managed care organizations (MCOs) require the same kind of oversight that fee-for-service programs receive from the Office of Inspector General (OIG), so OIG released a four-phase life cycle to align...

How Medicaid Network Adequacy Rules Affect Children with Special Needs

by Kelsey Waddill

Children with special health care needs (CSHCN) may experience access to care barriers as a result of new quantitative Medicaid network adequacy standards, a study published in Health Affairs...

States Use Managed Care, PACE, FAIs to Boost Dual Eligible Care Coordination

by Kelsey Waddill

Updated 5/2/2023: This article's title has been updated to say "States Use Managed Care, PACE, FAIs to Boost Dual Eligible Care Coordination." A previous version misspelled the acronym FAI as...

CMS Proposes Transparency, Access Standards for Medicaid Managed Care

by Victoria Bailey

The Centers for Medicare and Medicaid Services (CMS) has released two proposed rules that would establish national access standards for Medicaid managed care plans and increase transparency of Medicaid...

Update on the Massachusetts Medicaid Redetermination Process

by Kelsey Waddill

MassHealth is pursuing a multi-pronged approach to reducing coverage loss during the Medicaid redetermination process, an issue brief from Manatt Health explained. The researchers noted that...

UPMC Partnership Facilitates Access to Healthcare Services, Coverage

by Victoria Bailey

UPMC Health Plan’s Medicaid managed care plan is partnering with a community-based organization to provide access to navigation assistance that can help connect members to healthcare services and...

How Medicaid Managed Care Orgs Can Better Invest in SDOH Interventions

by Victoria Bailey

Medicaid managed care organizations can leverage financial bonds to help increase funds for social determinants of health interventions and avoid underinvesting, according to research published in...

The Role of Medicaid Managed Care Organizations in the PHE Unwinding

by Kelsey Waddill

Medicaid managed care organizations have a key role to play in the public health unwinding, a Kaiser Family Foundation (KFF) brief found. The brief’s findings are based on two study components:...

19 States Must Align Medicaid Vaccine Coverage Policies with IRA

by Kelsey Waddill

Almost two-fifths of US states—particularly those that have avoided Medicaid expansion—will need to change their Medicaid vaccine coverage policies in order to align with the Inflation...

ACHP Offers 5 Recommendations For CHIP, Medicaid During PHE Unwinding

by Kelsey Waddill

The Alliance of Community Health Plans (ACHP) had five recommendations for CMS regarding how to streamline processes in Medicaid, Children’s Health Insurance Program (CHIP), and the Basic Health...

OUD Treatment Coverage, Prior Authorizations Common in Medicaid FFS

by Victoria Bailey

Medicaid fee-for-service (FFS) programs were more likely to cover medications for opioid use disorder (MOUD) but imposed more prior authorizations for the treatments compared to Medicaid managed care...

How AZ Medicaid Expanded Its Role in Social Determinants of Health Coverage

by Kelsey Waddill

In September 2022, Arizona Health Care Cost Containment System (AHCCCS)—Arizona’s Medicaid program—received the Robert Wood Johnson Foundation’s 2022 Medicaid Innovation Award in “Initiatives to Address Social...

37% of People Switched Health Insurance Plans During Perinatal Period

by Victoria Bailey

More than a third of individuals with continuous coverage switched health insurance plans during the 12 months before or after giving birth, a study published in JAMA Network Open found. Switching...

OIG: Medicaid Managed Care Plans Submit Incomplete MLR Reports

by Victoria Bailey

Almost half of medical loss ratio (MLR) reports from state Medicaid managed care plans were incomplete, indicating the need for CMS to increase states’ oversight of MLR reporting, the Office of...

Recent Articles