Kaiser Family Foundation Survey on State Medicaid Managed Care ...

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for reliable encounter data, implementation of ICD-10, and state workload burden andadministrative capacity.While about half the states reported that their MCOs will be able to handle increased Medicaidenrollment under health reform, others were uncertain or did not respond. Of the 36 states with MCOs,30 responded to a question about MCOs’ capacity to accommodate increased Medicaid enrollmentunder the ACA. Of these 30 states, 20 said that they thought the MCOs serving Medicaid in their statehad or could develop sufficient network capacity (Figure 9), while one state said its current MCOs couldnot. Nine states responded that they did not know whether or not their MCOs could develop thenecessary capacity, and six states did not respond to this survey question.2019Can MCOs absorbMedicaid enrollmentgrowth under ACA?Figure 9Medicaid MCOs and Health Reform(27-30 states responding)13512Medicaid MCOsinterested inExchange?Yes No Don't KnowNote: 36 states contract with MCOs.SOURCE: KCMU/HMA <strong>Survey</strong> of Medicaid Managed Care, September 2011.82State consideringrequiring MCOs to be inExchange?17 1773State considering requiringExchange plans to be inMedicaid?Key health reform implications forMedicaid managed care are yet to comeinto focus in many states. Questionsregarding the participation of MCOs inboth Medicaid and the Exchange underhealth reform remain largely unanswered.Of the 36 states with MCOs, 30 respondedto a question regarding Medicaid MCOinterest in becoming Exchange plans. Ofthese states, 13 said that MCOs hadexpressed such an interest, five said theyhad not, and 12 states said they did notknow. Medicaid officials were even moreuncertain about whether their states mightrequire one or more Medicaid MCOs toparticipate in the Exchange, or one ormore Exchange plans to participate in Medicaid. A majority of the 27 states responding to this questionsaid they did not know since these decisions were to be considered in the future in their state.Several states identified barriers that might prevent or discourage Medicaid MCOs from becomingExchange plans, but others were optimistic that MCOs could and would want to participate. While,again, there was substantial uncertainty among the states about MCOs’ perspectives on participating inthe Exchange, several states identified potential issues and barriers facing plans, including possiblevariance between Medicaid and Exchange regulatory requirements, separate rate-setting andunderwriting issues for exchange plans, the challenge of building provider networks appropriate to serveboth non-Medicaid and Medicaid enrollees efficiently and effectively, different rules for marketing andcollection of premiums, and higher capital reserves needed before they could expand. Other states sawparticipation in the Exchange as doable for some plans or as a market opportunity that no plan wouldwant to miss.50 00
ConclusionFor over 30 years, state Medicaid programs have relied increasingly on managed care. The number andtype of managed care arrangements used by states to deliver and finance care for Medicaid enrollees, aswell as the number and share of Medicaid beneficiaries enrolled in these arrangements, have grownsteadily. Growth in Medicaid managed care is expected to continue, driven by budget pressures tocontain Medicaid spending and by the influx of millions of new adult Medicaid enrollees when the ACAtakes full effect in 2014. As individual states look for new ways to improve health care quality, improveaccess, and achiever greater value for state dollars, there is much to be learned from the wide andevolving variety of Medicaid managed care program designs and experiences that can be found acrossthe country.This survey documents the diversity in current state Medicaid managed care approaches and activity,and state policymakers’ perspectives on the value of managed care as a strategy to improve access,quality, and accountability, and to promote cost-effective care and better health outcomes. As such, itprovides a baseline against which to measure and monitor what are likely to be importantdevelopments and trends in the coming years.An assessment of the impact of Medicaid managed care was beyond the scope of this project, whichsurveyed state policy officials alone and gathered largely descriptive information. Robust evaluations ofMedicaid managed care will require extensive analyses that include investigations of beneficiary andprovider experiences and perspectives, as well. Particularly as states expand managed care to Medicaidbeneficiaries with more complex needs, and as they determine the delivery systems that will servemillions more low-income Americans in the future, evaluative research is crucial, as are federal and stateefforts to assess performance, to develop mechanisms to identify and resolve problems in meetingbeneficiaries’ needs, and to assure high quality care for all those served by Medicaid through managedcare.51
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Page 5 and 6: Table of ContentsExecutive Summary
Page 7 and 8: EXECUTIVE SUMMARYMedicaid, the publ
Page 9 and 10: party enrollment brokers to provide
Page 11 and 12: HEDIS©, CAHPS©, and state-specifi
Page 13: ConclusionFor over 30 years, state
Page 16 and 17: from the recession and the slow rec
Page 18 and 19: A note on Medicaid managed care ter
Page 20 and 21: Managed caremodelTable 1: Medicaid
Page 23 and 24: States are increasingly mandating m
Page 25 and 26: States with Medicaid MCOsKey Sectio
Page 27 and 28: States have “auto-assignment” a
Page 29 and 30: excess of a specified threshold for
Page 31 and 32: Dental care and outpatient and inpa
Page 33 and 34: the second trimester, and within th
Page 35 and 36: eported that they limit PCP panel s
Page 37 and 38: States with non-comprehensive PHPsK
Page 39 and 40: Measuring, monitoring, and improvin
Page 41 and 42: seven states required 10 measures o
Page 43 and 44: CAHPS© surveys. North Carolina is
Page 45 and 46: Special initiatives to improve qual
Page 47 and 48: public health efforts to reduce dis
Page 49 and 50: Medicaid managed long-term care and
Page 51 and 52: (e.g., need to credential Adult <st
Page 53 and 54: In many states, broader efforts foc
Page 55: Looking ahead: Medicaid managed car
Page 59 and 60: APPENDIX 2: Summary of Medicaid Man
Page 61 and 62: Program Name(e.g., Popular Name, 19
Page 63 and 64: APPENDIX 3: MCO Contracts, Plan Cha
Page 65 and 66: State(No. ofcontracts)NameEnrollmen
Page 67 and 68: State(No. ofcontracts)NameEnrollmen
Page 69 and 70: APPENDIX 5: MCO Capitation Rate-Set
Page 71 and 72: APPENDIX 7: MCO Network Adequacy Re
Page 73 and 74: State Primary Care Obstetric Care S
Page 75 and 76: APPENDIX 9: Providers Recognized as
Page 77 and 78: APPENDIX 11: PCCM Administrative Se
Page 79 and 80: APPENDIX 13: Initiatives to Improve
Page 81 and 82: I. MANAGED CARE OVERVIEW1. Total Ma
Page 83 and 84: 4. Enrollment Requirements.a. We ar
Page 85 and 86: ii. Please indicate whether the fac
Page 87 and 88: c. Required Providers: We are inter
Page 89 and 90: IV. NON-COMPREHENSIVE PREPAID HEALT
Page 91 and 92: . Does your state use CAHPS© surve
Page 93 and 94: VI. SPECIAL INITIATIVESAll states s
Page 95 and 96: Appendix I: Managed Care Contracts1
Page 97: Appendix II: Clinical Quality Perfo
Page 100: 1330 G S T R E E T NW, W A S H I N
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