States may choose to adopt managed care in Medicaid for a
number of reasons. For example, they may be interested in improving care
management and coordination. Others may wish to gain more predictability in
spending or increase accountability for access to providers and quality of
care. No matter what the reason (or combination of reasons), more states seem
to be eyeing managed care in Medicaid. A number of new resources are
available to help them (and advocates) navigate the subject:
- Our new favorite data source, MACPAC, released its
second report to Congress in June. The report, which examines the
evolution of managed care in Medicaid, finds that approximately 49 million
enrollees (71%) are in some form of managed care arrangement (although most
Medicaid enrollees still receive at least some services through fee for
service). 60% of non-disabled children are enrolled in managed care in Medicaid
and 75% of kids in CHIP (including those in CHIP-funded Medicaid expansions)
are enrolled managed care. In addition to providing background information on
managed care in Medicaid (for example payment policies), its MACStats section
presents state-level data highlighting enrollment, service use, spending, and
characteristics of individuals with disabilities.
- The Commonwealth Fund released a report examining how Medicaid managed care health plans differ. Since 2004, publicly
traded health plans have played an increasingly significant role in Medicaid
managed care. This study found that publicly traded plans with primarily a
Medicaid focus, paid out the lowest percentage of their revenues in medical
expenses. Additionally, they reported the highest percentage in administrative
expenses. Publicly traded plans also received lower scores for quality-of-care
measures related to preventive care, treatment of chronic conditions, access to
care, and customer service. All important issues to keep in mind when
considering whom to contract with.
- From a children’s perspective, Jane Perkins at the
National Health Law Program compiled a list of 30 questions to ask
about managed care and EPSDT. This is a great resource for advocates to turn to
as they examine whether the essential elements are included in contracts and
Requests for Proposals (RFPs) between the state Medicaid agency and managed
care plans.