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A Profile of Medicaid Managed Care Programs in 2010: Findings from a 50-State Survey

Most Medicaid beneficiaries nationally are enrolled in some form of managed care, and, with current budget pressure and health reform on the horizon, states are expected to increase their reliance on managed care to deliver services in their Medicaid programs.

This 50-state survey, conducted by the Kaiser Commission on Medicaid and the Uninsured and Health Management Associates, provides a comprehensive look at state Medicaid managed care programs, documenting their diversity, examining how states monitor access and quality, and exploring emerging efforts to improve care, including managed long-term care and initiatives targeted toward dual eligibles.

Among the key findings:

  • Two-thirds of Medicaid beneficiaries nationally are enrolled in comprehensive managed care programs, including risk-based managed care organizations (MCO) and primary care case management programs (PCCM). This does not include enrollees in less comprehensive managed care arrangements, known as prepaid health plans (PHP).
  • Almost two-thirds of those enrolled in Medicaid MCOs are in plans that serve Medicaid enrollees primarily or exclusively. Beneficiaries in MCOs are evenly split between for-profit and non-profit plans.
  • States increasingly are turning to managed care for Medicaid beneficiaries with more complex needs. A majority report that, for at least one Medicaid managed care program and/or geographic area, they now require enrollment in managed care for populations such as disabled children receiving Supplemental Security Income (SSI), children with special health care needs, and seniors and people with disabilities. In addition, half of states report some enrollment of dual eligibles in managed care.
  • Key health reform implications for Medicaid managed care are yet to come into focus in many states. Only about half of states with MCOs report that their plans have or could develop enough capacity to absorb the increased Medicaid enrollment under health reform. Uncertainty is wider concerning state intentions to require Medicaid MCOs to participate in the Exchanges or Exchange plans to participate in Medicaid.

The survey was released Sept. 13, 2011, at a public briefing at the Kaiser Family Foundation’s Washington, D.C., office.

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