Managed Care, Medicaid

Notes on Medicaid/MCOs

Uninsured Medicaid Eligibles/Enrollment Process

  • States design and administer their own Medicaid programs within federal rules.” (KFF.org)
  • 5.2 million Medicaid eligibles would remain uninsured if all states operated under Medicaid expansion rules. 
  • To solve the remainder of the Medicaid eligibility problem and fulfill the promise of universal care for those who are most needy, all states should operate under the same eligibility rules.
  • One solution to the uninsured problem is Continuous Autoenrollment with Retroactive Enforcement (CARE), as proposed by the Urban Institute

Medicaid Managed Care (KFF.org)

  • “As of July 2017, over two-thirds (69%) of all Medicaid beneficiaries received their care through comprehensive risk-based” managed care organizations. [1]
  • “A number of large health insurance companies have a significant stake in the Medicaid managed care market” including: UnitedHealth Group, Centene, Anthem, Molina, Aetna and WellCare.  All of the above Medicaid MCOs serve other populations as well. 
  • Medicaid has deep roots and specific care systems in place everywhere and no one else is capable of getting to where they are now in any reasonable time frame. (George?)