Medicaid managed care has evolved over time; new authorities have been created and states have gained experience administering managed care programs for different populations. The regulatory framework has changed too. The 2016 Medicaid managed care rule standardized key managed care requirements such as access to care, beneficiary protections, quality of care standards, rate setting, and contract approval across managed care authorities.
This presentation compares the current, divergent requirements for eligibility, application, approval and renewal, transparency, and monitoring and reporting under the Social Security Act’s Section 1115 and 1915(b) waiver authorities and Section 1932 state plan authority. It also puts forward several policy options to streamline these authorities to reduce administrative burden for states and the federal government, while ensuring sufficient protections for Medicaid enrollees.