Medicaid Managed Care Expenditures, Screening of Providers, and Utilization Patterns

The importance of managed care in Medicaid -- under which states contract with managed care organisations (MCOs) to provide a specific set of services -- has increased as states expand eligibility for Medicaid under the Patient Protection and Affordable Care Act (PPACA) and increasingly move populations with complex health needs into managed care. States have flexibility within broad federal parameters to design and implement their Medicaid programs, and therefore play a critical role in overseeing managed care. This book analyzes federal expenditures for Medicaid managed care and the range in selected states payments made to MCOs; selected states medical loss ratio (MLR) standards and how they compare with federal standards for other sources of health coverage; and selected states methods for automatically assigning Medicaid beneficiaries to MCO plans. Furthermore, this book examines states and plans experiences using federal databases to screen providers; and how states and plans share data about ineligible providers.