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Current and Emerging Issues in Medicaid Risk-Based Managed Care: Insights from an Expert Roundtable

Half of all Medicaid enrollees receive care through comprehensive risk-based managed care organizations (MCOs). Most Medicaid MCO enrollees today are low-income children and parents, but states are increasingly moving beneficiaries with more complex needs into MCOs. Managed care enrollment may grow more rapidly as states work with the Centers for Medicare & Medicare Services (CMS) to implement initiatives to better integrate Medicare and Medicaid benefits and care for dual eligibles.

The Foundation’s Kaiser Commission on Medicaid and the Uninsured (KCMU) convened an expert roundtable meeting in Washington, DC on May 30, 2012 to learn more about how Medicaid MCOs are currently organized, consider issues that the enrollment of higher-need populations in MCOs raises, and to discuss the implications for MCOs of the expansion of Medicaid under the Affordable Care Act (ACA). The meeting provided insights that complement the findings from a 50-state survey of Medicaid managed care that KCMU conducted in late 2010 in partnership with Health Management Associates.

Roundtable participants included state Medicaid officials and insurance regulators, consumer advocates, executives from a diversity of firms operating MCOs, and other key stakeholders. The roundtable discussion sheds light on important managed care-related practices and concerns, but does not statistically quantify their prevalence in industry or the nation.

Issue Brief (.pdf)

Executive Summary (.pdf)