Medicaid and Managed Care
Managed care is a health care system under which doctors, hospitals and other caregivers are organized into a group or network to manage the cost, quality and access to health care. Since the early 1980s, states have relied increasingly on managed care to serve their Medicaid beneficiaries. Two-thirds of Medicaid enrollees now receive most or all of their benefits in managed care and many states are expanding their use of managed care to additional geographic areas and Medicaid populations. Studies investigating the savings impact of Medicaid managed care have produced mixed results. Findings appear to depend on many factors related to the specifics of states’ baseline Medicaid programs and their managed care contracts and the analytic strategy used in the research. Greater use of managed care in Medicaid is likely to continue, fueled by interest in improved care delivery and payment systems, ongoing state budget pressures and federal funding opportunities that promote managed care.
For more information on managed care, please see the list of NCSL resources on the right or the list of new resources and publications below.
State, Federal and Expert Reports
Medicaid Managed Care - Costs, Access, and Quality of Care.
September 2012 published by Robert Wood Johnson Foundation. "The Affordable Care Act encourages states to implement a major expansion in Medicaid eligibility. Many of the new beneficiaries will be enrolled in Medicaid managed care. At the same time, states increasingly are looking to managed care to cover more high-cost populations and services. In addition to potential savings, states value the budget predictability that comes from managed care. Consumer advocates and providers, however, have expressed concerns about network adequacy, access to care and quality of care, especially as states move more high-cost populations to managed care.
This synthesis examines the evidence on whether states have saved money using managed care for their Medicaid populations and whether managed care beneficiaries have better access to services or receive higher quality care than their fee-for-service counterparts. Key Findings:
- There is little evidence of national savings from Medicaid managed care, but a few states have had some success. The states that did realize cost savings were more likely to be states with relatively high reimbursement rates under fee-for-service.
- Medicaid managed care has had mixed success in improving access to care. There is some evidence of increased likelihood of a usual source of care and reduced emergency department visits, but pregnant women were generally no better off under managed care then in fee-for-service.
Full report = 36 pages http://www.rwjf.org/content/dam/farm/reports/reports/2012/rwjf401106 -
NEW for 2015:
Medicare and Medicaid Market Data: 2015.— In-house researchers for Atlantic Information Services, Inc. (AIS) report that Anthem, Inc. was the country's top Medicaid insurer as of first quarter 2015, with nearly 4.8 million lives. The major Medicaid insurers (with market share) as of early 2015 are:
> Anthem = 10.27% and 4.8 million enrollees
> UnitedHealthcare = 9.59% and 4.47 million enrollees
> Centene Corporation = 6.8%
> Molina Healthcare, Inc. = 4.8%
> WellCare Health Plans, Inc. = 4.8%
> Health Net (CA) = 3.7%
> L.A. Care = 3.5%
> Triple-S = 3.1%
> Aetna = 2.8%
> Amerihealth Caritas = 2.4%
> 167 other companies constituted the remaining 48.5%
For California Medicaid, Health Net, Inc. had the highest enrollment of any Medicaid plan in the United States, with 1.63 million; its closest competitor is also a California plan, L.A. Care, which had 1.61 million enrollees as of the first quarter of 2015. California — the most populous state — has the most Medicaid enrollees at 10.2 million. This represents an increase of 52% from the end of 2013, reflecting the state's managed Medicaid expansion efforts.
Researchers also found that Medicaid enrollment in the U.S. as of the first quarter of 2015 grew by almost 11 million from the fourth quarter of 2013, representing the impact of the Affordable Care Act's Medicaid expansion initiatives. Enrollment grew by more than two million since a 2014 mid-year Medicaid update.
[Added 10/12/2015 - R. Cauchi]