Managed Care
Managed care is the primary Medicaid delivery system in more than half the states. States have incorporated managed care into their Medicaid programs for a number of reasons, including:
- Managed care provides states with some control and predictability over future costs.
- Compared with fee for service, managed care can allow for greater accountability for outcomes and can better support systematic efforts to measure, report, and monitor performance, access, and quality.
- Managed care programs may provide an opportunity for improved care management and care coordination.
Close to half of federal and state Medicaid spending in fiscal year 2017 (over $283 billion) was on managed care. The proportion continues to grow each year. As of 2016, over 90 percent of Medicaid beneficiaries were enrolled in some form of managed care, up from about 56 percent in 2000. MACPAC annually compiles updated information on managed care spending and enrollment.
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Learn More about These Topics
- Managed care’s effect on outcomes
- Monitoring managed care access
- Medicaid managed care payment
- Data for program accountability and policy development
- Enrollment and spending on Medicaid managed care
- Managed care program integrity
- Key federal program accountability requirements in Medicaid managed care
- Types of managed care arrangements
- Enrollment process for Medicaid managed care
- Managed care overview
Featured Publications
Proposed Recommendations for Improving Managed Care External Quality Review
December 12, 2024
Following up on the Commission’s discussion at the October 2024 meeting on policy options for improving the managed care external quality review process (EQR), staff presented draft text for proposed recommendations for MACPAC’s March 2025 report to Congress. The proposed recommendations are intended to improve the transparency and usability of findings included in the EQR […]
State and Federal Tools for Ensuring Accountability of Medicaid Managed Care Organizations
December 12, 2024
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 […]
Directed Payments in Medicaid Managed Care
October 31, 2024
In 2016, the Centers for Medicare & Medicaid Services (CMS) updated the regulations for Medicaid managed care and created a new option called directed payments for states, allowing them to direct managed care organizations (MCOs) to pay providers according to specific rates or methods. Since their initial implementation, directed payment arrangements have grown rapidly in […]
