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The Value of Medicaid Managed Care

December 9, 2015

In “The Value of Medicaid Managed Care,” HMA authors Lisa Shugarman, Jaimie Bern and Jessica Foster review the literature describing the evolving Medicaid delivery system, focusing specifically on the growth of Medicaid managed care in the form of comprehensive risk-based managed care (RBMC) organizations. The paper, prepared for United HealthCare, also explores the role of Medicaid RBMC relative to the fee for service (FFS) delivery system and draws comparisons of the experience of these delivery systems from the perspective of the Medicaid beneficiary, the provider, and the state.

The paper concludes by sharing lessons learned from the last decade of Medicaid managed care expansion, including:

  • Planning and implementation
  • Stakeholder engagement
  • Procurement approaches
  • Outreach and enrollment
  • Contract management and monitoring

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Making Affordable Care Act Coverage a Reality: A National Examination of Provider Network Monitoring Practices by States and Health Plans

October 28, 2015

Robert Wood Johnson Foundation

Karen Brodsky | Principal | Contributor
Diana Rodin, MPH | Senior Consultant | Contributor
Barbara Markham Smith, JD | Principal | Contributor

This qualitative study examines the standards and practices that state agencies and health plans use to ensure access to care in the period following the implementation of the Affordable Care Act (ACA). Based on evidence gathered through surveys of and interviews with key informants in state agencies and plans, the study explores the standards applied by commercial insurance regulators and Medicaid agencies and the practices actually employed by Medicaid managed care organizations (MMCOs) and Qualified Health Plans (QHPs) in Marketplaces to form provider networks and monitor performance. While the response sample is small, the information provided paints a picture of the range of standards and practices used and the challenges faced, which provides a basis for identifying gaps in current understanding and strategies and opportunities for developing best practices.

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A Primer on Medicaid Managed Care Capitation Rates: Understanding How MassHealth Pays MCOs

October 27, 2015

Massachusetts Medicaid Policy Institute

HMA Senior Consultant Ellen Breslin prepared this recently released primer for the Massachusetts Medicaid Policy Institute. It includes:

  • An explanation of how state Medicaid programs generally pay their managed care organizations (MCOs)
  • The overall process for setting Medicaid managed care capitation rates; and
  • The various tools states use to mitigate the risks that MCOs face when they assume financial responsibility for Medicaid members.

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Annual Survey Finds ACA Drove Record Annual Increases in Enrollment, Total Medicaid Spending

October 16, 2015

The Kaiser Family Foundation’s Commission on Medicaid and the Uninsured

The Affordable Care Act’s Medicaid expansion resulted in record increases in Medicaid enrollment and spending nationally in fiscal year 2015, with both rising an average of nearly 14 percent. This is just one finding in the 15th annual 50-state Medicaid budget survey by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured.

Released Oct. 15, this report provides an in-depth examination of the changes taking place in state Medicaid programs across the country. Health Management Associates conducted the survey of Medicaid directors across the country. The survey shows big differences across states driven largely by the states’ decisions on the Medicaid expansion and also provides an examination of state Medicaid policy and program changes across the country. 

HMA Managing Principals Vernon K. Smith, Kathleen Gifford and Eileen Ellis authored the report along with Robin Rudowitz, Laura Snyder and Elizabeth Hinton of the Kaiser Family Foundation.

Two additional issue briefs were developed as well:

Medicaid Enrollment & Spending Growth: FY 2015 & 2016, which provides an analysis of national trends in Medicaid enrollment and spending.

Putting Medicaid in the Larger Budget Context: An In-Depth Look at Three States in FY 2015 and 2016, a collection of three case studies of Medicaid programs in Alaska, California and Tennessee.

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Medicaid Enrollment & Spending Growth: FY 2015 & 2016

October 16, 2015

The Kaiser Family Foundation’s Commission on Medicaid and the Uninsured

This issue brief was released Oct. 15 by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) in conjunction with its 15th annual budget survey of Medicaid officials, “Medicaid Reforms to Expand Coverage, Control Costs and Improve Care: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2015 and 2016.”

HMA Managing Principal Vernon K. Smith and Robin Rudowitz and Laura Snyder of the Kaiser Family Foundation authored this brief.

Executive Summary

Beginning in Fiscal Year (FY) 2014, policy changes introduced by the Affordable Care Act (ACA) have been driving Medicaid enrollment and spending growth. This report provides an overview of Medicaid enrollment and spending growth with a focus on state FY 2015 and state FY 2016. Findings are based on interviews and data provided by state Medicaid directors as part of the 15th annual survey of Medicaid directors in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured (KCMU) and Health Management Associates (HMA). Information collected in the survey on policy actions taken during FY 2015 and FY 2016 can be found in the companion report. Key findings related to Medicaid enrollment and spending growth are described in this report.

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Putting Medicaid in the Larger Budget Context: An In-Depth Look at Three States in FY 2015 and 2016

October 16, 2015

The Kaiser Family Foundation’s Commission on Medicaid and the Uninsured

This issue brief was released Oct. 15 by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) in conjunction with its 15th annual budget survey of Medicaid officials, “Medicaid Reforms to Expand Coverage, Control Costs and Improve Care: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2015 and 2016.”

HMA Managing Principal Kathleen Gifford, Principal Barbara Edwards and Senior Consultant Jenna Walls authored this brief with Laura Snyder and Elizabeth Hinton of the Kaiser Family Foundation.

The years 2015 and 2016 continue a period of significant change and transformation for Medicaid programs. With slow but steady improvements in the economy following the Great Recession, Medicaid programs across the country were focused on implementing a myriad of changes included in the Affordable Care Act (ACA), pursuing innovative delivery and payment system reforms with the goals of assuring access, improving quality and achieving budget certainty, and continuing to administer this increasingly complex program.

However, these changes to Medicaid policy take place in the larger context of states budgets. Unlike the Federal government, states generally have balanced budget requirements, taking into account the amount of revenue coming in from a state’s own resources as well as federal revenues. State lawmakers must balance competing priorities across budget expenditure categories. Even in years of economic growth, state lawmakers face this pressure of balancing priorities.

This report provides an in-depth examination of Medicaid program changes in the larger context of state budgets in three states:

  • Alaska
  • California
  • Tennessee

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