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...
Humana has announced its plan to acquire all of the assets of Inclusa; a Wisconsin-based Medicaid managed care organization.
Inclusa provides long-term care coverage to over 16,000 older adults and...
Health Net, a subsidiary of Centene and a payer partner of California’s Medicaid program known as Medi-Cal, has released an issue brief outlining some best practices for providing community...
The US Department of Health and Human Services (HHS) released new resources through CMS, aiming to improve the quality of care that Medicaid and the Children’s Health Insurance Program (CHIP)...
Despite CMS efforts to expand oversight of Medicaid managed care direct payments and the US Government Accountability Office’s (GAO’s) previous recommendations to improve processes, the...
Medicaid can help reduce youth homelessness among individuals with behavioral health needs by expanding coverage, incentivizing cross-agency coordination, and increasing plan oversight and...
Anthem has finalized its acquisition of Integra Managed Care, the payer announced.
Integra is a managed care company that offers managed long-term care plans. The organization serves four areas in the...
The Massachusetts Medicaid program can use a variety of strategies that it might implement in order to reduce coverage loss after the public health emergency lifts, according to a brief from the Blue...
Around one-third of primary care and specialty physicians that contracted with Medicaid managed care plans saw fewer than ten Medicaid beneficiaries over a year, suggesting that network adequacy...
In general, Medicaid managed care organizations (MCOs) have better provider network adequacy standards at the federal level than marketplace qualified health plans (QHPs), but standards varied...
States have four main tools at their disposal for managing risk in Medicaid managed care organizations, according to a MACPAC issue brief.
Medicaid managed care organizations are reimbursed in a...
Medicaid managed care enables care coordination, incorporation of social determinants of health into care, trust-building between healthcare stakeholders, stakeholder accountability, and flexibility...
Payers can leverage beneficiary surveys, opportunities to share lessons learned, and social services referral platform data in order to assess the return on investment for social determinants of health...
Medicaid managed care organizations (MCOs) may be better equipped to address members’ social determinants of health and health equity compared to fee-for-service models, according to a report...
Transitioning elderly and disabled Medicaid beneficiaries from fee-for-service Medicaid to a managed care model may lead to improved health outcomes and more than $100 billion of savings for states and...
Efforts to create a federal public option health plan may have stalled, but public options on the state level are slowly emerging, according to a Manatt Health mid-year update.
While President...
Updated 6/11/2021: This article has been updated with a quote from Blue Cross and Blue Shield of Minnesota's chief medical officer. A previous version included an quote from a partner of Blue...
Affordable Care Act marketplace premiums have dropped for the third consecutive year and themes are emerging as the marketplace becomes more stable, a recent Urban Institute report found.
“In...
Gross margins and medical loss ratios from 2020 may confirm that payer profitability increased during the coronavirus pandemic, according to a brief from Kaiser Family Foundation.
The researchers...
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) initiated enrollment in its new Medicaid managed care plan known as Healthy Blue, the payer announced.
The Medicaid managed care plan has a...
