Managed Care

This issue brief merged beneficiary-level Medicare and Medicaid data from 2021 to document sources of coverage for dual-eligible individuals nationwide and by state.

This report highlights certain policies in place in state Medicaid programs in FY 2024 and policy changes implemented or planned for FY 2025, which began on July 1, 2024 for most states.

This policy watch examines the burden of medical debt in North Carolina and the state’s new plan to leverage the Medicaid program to provide debt relief and support access to care for low- and middle-income North Carolinians.

This brief examines the two presidential candidates’ records and other recent policy proposals that could inform starkly different directions for the program across key areas, including Affordable Care Act (ACA) Medicaid expansion, financing, eligibility, benefits, and cost-sharing, prescription drugs, long-term services and supports, and managed care.

Using health insurer financial data for 2023, we find that in 2023, per enrollee gross margins were highest in the Medicare Advantage market, and medical loss ratios were lowest in the individual insurance market. Across most markets, gross margins have been relatively stable in recent years.

Medicaid programs are a major source of coverage for people of color and a potential mechanism to address racial health disparities. This issue brief provides insight into ways Medicaid can mitigate racial health disparities, how coverage may vary by race and ethnicity, and other Medicaid initiatives states pursuing to address racial disparities in health and health care.

This brief examines the final CMS regulations governing prior authorization in Medicare Advantage, Marketplace, Medicaid, and other plans, how they might address some current consumer concerns, and some issues that remain.

Managed care is the most common delivery system for Medicaid. Most states (42, including DC) use comprehensive managed care plans to provide care to at least some of their Medicaid enrollees, according to KFF’s updated explainer.  Roughly 3 out of 4 Medicaid enrollees receive care through managed care organizations and…

Our updated explainer provides an overview of comprehensive managed care, the most common way states deliver Medicaid services to enrollees, as well as new federal rules that strengthen managed care access standards.