Managed Care

This issue brief was published by Justice in Aging, as a part of its four part series “Risks and Rewards of Demographic Data Collection: How Effective Data Privacy Can Promote Health Equity.” This brief highlights the privacy concerns faced by individuals who are enrolled in Dual Eligible Special Needs Plans (D-SNPs) or other models that coordinate care across programs, and discusses best practices that plans can put in place to strengthen protections for these vulnerable populations.

A new issue brief from Kaiser Family Foundation shares how States can work with Medicaid managed care organizations (MCOs) to prepare beneficiaries for the unwinding process. MCOs deliver to more than two thirds of Medicaid beneficiaries nationally and this article shares insight on the strategic partnerships between states and their MCOs to prepare for the unwinding process.

This brief explores design considerations and policy levers Medicaid agencies may consider for encouraging uptake of tech-enabled innovation within Medicaid managed care. The brief is a product of the Medicaid Innovation Collaborative, which brings together Medicaid programs, their managed care plans, and other stakeholders to spread tech innovations that can improve the health of Medicaid populations. The collaborative is led by Acumen America, Adaptation Health, and the Center for Health Care Strategies and supported by The MolinaCares Accord, CommonSpirit Health, and Hopelab.

When states use a Medicaid managed care delivery system, the contracted managed care organizations (MCOs) generally determine provider payment rates. However, in certain circumstances states may direct payments to providers through the MCOs in accordance with state-set criteria. In this report, GAO describes (1) the use of state directed payments in Medicaid, and (2) CMS's changes to guidance and oversight of these payments.

On Monday, June 13, 2022 CMS released the 2020 Medicaid Managed Care Enrollment and Program Characteristics and Data Tables. This national data is broken down by program, population, and individual state. The enrollment data provides a snapshot of Medicaid managed care enrollment as of July 1, 2020.

Medicaid value-based payment (VBP) models tie payment to outcomes including quality of care, health status, and costs. This guide presents a checklist of four issues for consideration as states identify issues to consider when developing and adopting value-based payment (VBP) models for HCBS within managed long-term services and supports (MLTSS) programs. The guide also reviews strategies for stakeholder engagement.

This recently released report examines the reforms, policy changes, and initiatives that occurred in FY 2018 and those adopted for implementation for FY 2019. The report focuses on changes in eligibility, managed care and delivery system reforms, long-term services and supports, provider payment rates and taxes, covered benefits, and pharmacy and opioid strategies.

This report presents information on managed care’s enrollment and spending. It explores the growth of enrollment in Medicaid Managed Care in the United States and the contributing factors. It also analyzes the fact that funding does not directly parallel enrollment, as the share of total Medicaid spending that went to managed care only grew from 15 percent to 37 percent between 1999 and 2012, despite enrollment growing from 63 percent to 89 percent during that same time period.

The Spring 2018 issue of Generations, the quarterly journal of the American Society on Aging, is divided into three main parts. These three sections are building community partnerships, building business practices, and examples of successful CBO use of business acumen. This issue also has a special focus on how the social determinants of health influence the experience of older adults in the community.

This interactive session, from n4a’s 2016 annual conference, helped participants learn how to tell their organization’s story and package their “products” in ways that will help them get noticed and appreciated by health care payers. Presenters included representatives from health plans who discussed what they look for in a “pitch” from a community-based organization seeking to market its services.