Research & Reports

October 2025 -

States are Increasingly Enrolling Seniors, People with Disabilities in Medicaid Managed Care

Historically, state Medicaid programs primarily enrolled low-income children and adults in comprehensive managed care (CMC) while keeping higher-risk populations like seniors and people with disabilities in fee for service. More recently, this trend has changed as states increasingly transition seniors and people with disabilities into CMC to improve consumer choice, service coordination, quality of care, and budget predictability.

This research brief looks at states’ growing confidence in CMC for Medicaid enrollees qualifying based on age (65+) or disability. The analysis uses T-MSIS enrollment data from 2019-2023 for enrollees receiving full or comprehensive benefits, excluding limited benefit enrollees (e.g., partial-benefit dual eligible enrollees).

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July 2025 -

How Medicaid Managed Care Plans Improve Health Outcomes with Quality Improvement Projects

Medicaid Managed Care Plans (MCPs) improve health outcomes by partnering with state Medicaid agencies through Quality Improvement Projects (QIPs). These federally required, multi-year projects test innovative strategies to address priority health issues such as behavioral health, chronic conditions, primary care access, and maternal health. QIPs involve rigorous oversight via independent External Quality Reviews (EQR) to ensure evidence-based methods and data accuracy, with findings used to enhance state Medicaid programs and share best practices.

In 2023-2024, over 1,200 QIPs were independently reviewed across 41 states, focusing on clinical and non-clinical areas including dental care, long-term supports, and enrollee experience. MCPs leverage their expertise in care coordination to implement and refine interventions, driving sustained improvements beyond traditional fee-for-service models.

Overall, QIPs are essential for advancing Medicaid quality, accountability, and health parity by fostering collaboration, innovation, and continuous improvement in managed care settings.

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April 2025 -

 

A Snapshot of Medicaid Managed Care

Medicaid managed care organizations (MCOs) partner with states to improve access to primary, preventive, and specialty services for the nation’s most vulnerable populations. The managed care model provides flexibility to address the local, diverse, and complex needs of Medicaid enrollees and improve health outcomes.

As state Medicaid agencies complete post-pandemic eligibility requirements, MCOs continue to play an important role in meeting the health care needs of Medicaid enrollees.

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October 2024 -

 

The Waiver Effect:
An Exploratory Analysis of Medicaid Enrollment Trends in the Presence of Waivers

New research from MHPA reveals that Medicaid Managed Care Organization (MCO)-specific waivers significantly impact enrollment during the unwinding of continuous enrollment. Our analysis of a full year of data shows that states utilizing two waivers experienced the lowest decline in net Medicaid enrollment (11.9% loss) compared to states with zero waivers (15.8% loss).

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July 2024 -

Snapshot of Medicaid with Managed Care - UPDATED 

Medicaid managed care organizations (MCOs) partner with states to improve access to primary, preventive, and specialty services for the nation’s most vulnerable populations. The managed care model provides flexibility to address the local, diverse, and complex needs of Medicaid enrollees and improve health outcomes.

As state Medicaid agencies complete post-pandemic eligibility requirements, MCOs continue to play an important role in meeting the health care needs of Medicaid enrollees.

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