Medicaid Managed Care Plans and Access to Care: Results from the Kaiser Family Foundation 2017 Survey of Medicaid Managed Care Plans

Introduction

Since the early 1980s, and particularly in recent years, states have increasingly used managed care to deliver services to Medicaid beneficiaries. The dominant model is comprehensive managed care, in which states contract with managed care organizations (MCOs) to provide comprehensive acute care — and in some cases long-term services and supports as well — to Medicaid beneficiaries and pay the MCO a fixed monthly premium or “capitation rate” for each enrollee. Historically, states largely limited risk-based managed care to pregnant women, children, and parents, but states are increasingly including Medicaid beneficiaries with complex needs, including people with disabilities and people over 65 years of age. Today, 39 states (including the District of Columbia) contract with comprehensive managed care plans to provide care to at least some of their Medicaid beneficiaries.¹ Nationwide, MCOs cover nearly two-thirds of all Medicaid beneficiaries,² making managed care the nation’s dominant delivery system for Medicaid enrollees. As the entities responsible for providing comprehensive Medicaid benefits to enrollees by contracting with providers, plans play a crucial role in shaping access to care for Medicaid enrollees.

To understand how Medicaid managed care plans approach access to care and the challenges they face in ensuring such access, the Kaiser Family Foundation conducted a survey of plans in 2017. The survey aimed to capture information on plans’ policies, procedures, and strategies for ensuring access to care as well as their priorities and challenges in facilitating access. The survey was fielded among all plans in operation during the survey (2017) and reference (2016) periods.³ The final sample of nearly 100 plans across 31 states captured approximately 40% of Medicaid beneficiaries in comprehensive MCOs. Additional detail on the methods underlying the survey and characteristics of plans, as well as full survey results, are available in Topline & Methodology Report, and a brief overview of the survey methods is below.

Overview of Survey Methods

The Kaiser Family Foundation Survey of Medicaid managed care organizations (MCOs) collected information about MCO policies, procedures, challenges, and priorities regarding enrollees’ access to care. The survey also collected information on key characteristics of MCOs and the impact of current policy developments on MCO operations. The Kaiser Family Foundation contracted with NORC at the University of Chicago to develop and field the web-based survey. The target population included all comprehensive Medicaid MCOs in the 39 states (including DC) that use comprehensive managed care for any Medicaid enrollees. Eligible plans included any plan that had a 2016 Medicaid MCO contract and was active during the data collection period in 2017. Data collection began on April 17, 2017 and concluded on September 21, 2017. The survey was distributed by email to executives at each MCO. Outreach to plan contacts occurred multiple times throughout the field period to encourage participation. The survey was offered in English only. A PDF of the survey instrument was provided to all respondents along with a link to the web-based survey. The response rate was calculated using American Association for Public Opinion Research (AAPOR) standards for establishment surveys. The final survey response rate was 34.3% (95 complete surveys out of 277 eligible plans). Three additional plans partially completed the survey. Comparison of the plans represented in data reporting to the universe of eligible plans indicates that responding plans represent 31 of 39 states and 38% of total comprehensive Medicaid managed care enrollment. Reporting plans were slightly more likely than the universe of plans to be non-profit and in states that expanded Medicaid under the ACA. Compared to the universe of eligible plans, reporting plans were similar in average Medicaid enrollment, geographic distribution, and state Medicaid MCO penetration.