Managed care is the predominant delivery system in Medicaid. As such, the effective oversight of Medicaid managed care programs is a priority for stakeholders. This session introduced a new project on Medicaid managed care accountability with a focus on the tools available to federal and state regulators to oversee states’ managed care programs. Specifically, MACPAC will examine how the Centers for Medicare & Medicaid Services regulate state Medicaid agencies and ensure compliance with federal regulations, and how state Medicaid agencies manage their contracted managed care organizations’ (MCOs) performance and hold plans accountable to contractual obligations.
Staff presented findings from MACPAC’s review of federal policy and a 40-state review of accountability tools described in requests for proposals, MCO contracts, and MCO performance summaries available on state websites. Staff reviewed the next phase of this work, including stakeholder interviews.
