Managed care is now the dominant delivery system in Medicaid, with the share of beneficiaries enrolled in any form of managed care growing from 58 percent in 2002 to 80 percent in 2015.
States can use three separate legal authorities to implement a Medicaid managed care program: Section 1115 waiver authority, Section 1915 waiver authority, and Section 1932 state plan authority. Many states operate more than one managed care program, often under multiple authorities or through multiple waivers. In Chapter 1, the Commission argues that allowing states a more streamlined mechanism to select managed care as their delivery system and to require beneficiaries to enroll in such systems is appropriate at this time. The Commission proposes three recommendations to update and streamline aspects of current Medicaid managed care authorities:
- Congress should amend Section 1932(a)(2) to allow states to require all beneficiaries to enroll in Medicaid managed care programs under state plan authority.
- Congress should extend approval and renewal periods for all Section 1915(b) waivers from two to five years.
- Congress should revise Section 1915(c) waiver authority to permit Section 1915(c) waivers to waive freedom of choice and selective contracting.