Evolution in Medicaid Managed Care


How are various states and MCOs responding to the challenges of a landmark year?

We sat down with healthcare data and policy analyst Allan Baumgarten for a conversation about how this important segment of the healthcare market is adapting to these challenges. 

In this post, we’ll cover some of the highlights of a recent report Allan published with the Robert Wood Johnson Foundation that analyzed various Medicaid programs and the key differences in the areas of procurement, contracting, and oversight.

Read on for the highlights or access the full conversation on-demand by filling out the form below.  

Because states have so much leeway in determining Medicaid markets, regulation, and requirements, we see many naturally occurring experiments created by divergent approaches.

Top Trends Affecting Medicaid Managed Care in 2020

  1. Recent Growing enrollment due to economic recession and job losses 
  2. Large and continuing dips in utilization
  3. Growth of digital and telehealth
  4. Continued Medicaid expansion: Missouri, Oklahoma, North Carolina
  5. Growth of alternative payment models

Three Areas Shaping Medicaid Managed Care Programs and Relationships with MCOs

After analyzing market data and interviewing more than 40: 

  1. Procurement Processes
    The priorities of agencies within their procurement process have shifted to place more importance on state goals such as integrating behavioral and physical health services and addressing health equity. 
  2. Contracting Terms
    Contracting terms and practices vary widely, especially with regard to rate setting and market participation and division. Allan unpacks how this plays out in several states.
  3. Oversight Requirements
    The way states approach oversight requirements really impact the relationships between MCOs in their state. We dig into a couple of approaches. 

The most effective Medicaid Managed Care relationships are continuously raising expectations.

Allan Baumgarten

Key Challenges Facing State Medicaid Agencies

  • Unclear changes in federal rules and requirements
  • Tightening budgets 
  • Internal resources and reliance on consultants

How are MCOs Standing Out in the Medicaid Market? 

  • Investing in SDOH programs
  • Addressing health equity
  • Pursuing value-based arrangements
  • Leading digital health experiences and promoting technology and accessibility.

We help MCOs meet complex requirements for provider network oversight.

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