MEDICAID MANAGED CARE 101

Transforming Healthcare: Discover MHPA's Role in Advocating for Medicaid Managed Care

All Access with Andy Garcia

Featured on All Access with Andy Garcia, discover how Medicaid Health Plans of America and its 150+ commercial and nonprofit plans are leading the way in delivering high-quality care to millions of Americans.

About Medicaid

Medicaid is a government program providing health care to approximately  81 million people, including low-income individuals, families, children, pregnant women, seniors, and people with disabilities.

Key Facts:

Medicaid managed care organizations (MCOs) partner with 40 states, the District of Columbia and Puerto Rico, to provide comprehensive, coordinated health coverage for the nation’s most vulnerable populations 

282 MCOs provide comprehensive Medicaid coverage to: 75% of Medicaid enrollees 

The Essential Impact and Role of MCOs

Role of Medicaid MCOs:

Medicaid MCOs provide states with the flexibility to address the holistic needs of Medicaid enrollees by emphasizing preventive and comprehensive care – all while helping states manage costs.  

Medicaid MCOs partner with states to deliver a wide range of benefits, including: 

  • Integrated, Coordinated Care: Care management teams personalize care plans and help enrollees access a broad array of health care services across settings and providers.    

  • Quality and Accountability: MCOs must meet quality reporting requirements, network adequacy standards, and other state and federal oversight, in addition to standards set by accrediting organizations. They drive innovations in care delivery that improve enrollees’ outcomes and quality of life.     
  • Budget Predictability and Cost Containment: States pay health plans prospectively for a comprehensive set of services and, in turn, health plans bear the risk of unexpectedly high utilization or spending.

Why Medicaid MCOs Matter

Statistics:

  • MCOs provide Medicaid coverage to 75% of Medicaid enrollees 
  • Medicaid MCOs save taxpayers $7.1 billion annually by improving healthcare efficiency and outcomes. 

Medicaid MCOs cover:

  • 32 million parents/caretaker
  • 29 million children
  • 5 million people with disabilities
  • 3 million seniors
  • 1 million individuals in long-term services and supports
Woman in wheelchair with nurse

Common Questions:

Medicaid MCOs partner with states to deliver high-quality, cost-effective care, improving healthcare efficiency and outcomes for millions of Americans. 

Medicaid provides essential health services to low-income individuals, families, and people with disabilities, ensuring they receive the care they need.

Medicaid MCOs save taxpayers billions annually while delivering better care coordination.