Medicaid program integrity activities traditionally have been designed to oversee fee-for-service delivery systems, but managed care is now the primary Medicaid delivery system in more than half the states. Federal and state responsibilities shift when states implement managed care delivery systems while managed care organizations assume direct program integrity responsibilities under the oversight of states.
This presentation summarizes a draft chapter in MACPAC’s forthcoming June 2017 report to Congress, reporting on a recent MACPAC study of state, federal, and managed care organization program integrity activities and the relevant provisions of the 2016 Medicaid managed care rule.