Transparency in Medicaid Managed Care: findings from a 13- state scan
- Collection:
- Health Policy and Services Research
- Author(s):
- Corcoran, Allie, author Hurler, Emma, author Schneider, Andy, author Buschmann, Julia, author
- Contributor(s):
- Georgetown University. Center for Children and Families. issuing body.
- Publication:
- Washington, DC : Georgetown University Health Policy Institute, Center for Children and Families, September 2021
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Child Health Managed Care Programs Maternal Health Medicaid United States State Children's Health Insurance Program (U.S.)
- Genre(s):
- Technical Report
- Abstract:
- Medicaid is the nation’s largest health insurer for children; more than one in three children in the United States are covered by Medicaid or CHIP. 1 The programs promise children a comprehensive pediatric benefit package at little to no cost and have been shown to improve health and educational outcomes well into adulthood.2 In 40 states, Medicaid coverage means enrollment in a Medicaid managed care organization (MCO). If the MCO fulfills its obligations to its beneficiaries, Medicaid coverage works; if the MCO does not, Medicaid continues to spend but its full promise is not realized. In this paper we ask the question: Does the public have the information needed to tell whether or not MCOs are fulfilling their responsibilities to children and pregnant individuals* enrolled in Medicaid? We find that, in the states we examined, the answer is “no.” Over a 12-month period, June 2020 through May 2021, we searched the websites of state Medicaid agencies, state insurance departments, and individual MCOs for information on the performance of 56 MCOs in 13 states: Arizona, Georgia, Illinois, Iowa, Kansas, Kentucky, Mississippi, Missouri, Nevada, Pennsylvania, Tennessee, Utah, and West Virginia. We searched for a set of basic, non-proprietary data elements that could help us gauge how individual MCOs are performing. These included the number of children enrolled in an individual MCO, disaggregated by age, race, and ethnicity; whether those children received the Medicaid pediatric benefit, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, to which they were entitled; measures of the quality and accessibility of covered pediatric and maternity services; and the amount of money the state paid each MCO to furnish services to children and pregnant individuals. We also searched for information relating to the structure and organization of MCOs required by federal transparency regulations.3 Of the 13 state Medicaid agency websites we scanned, only three posted the number of children enrolled in each MCO, and only two posted the number of pregnant women* enrolled. Only one posted the amount the state paid each MCO to furnish services. No state posted information on receipt of EPSDT services (other than dental care) by children enrolled in each MCO. And none of the 13 states posted enrollment, EPSDT, or child and maternal health quality data disaggregated by race and ethnicity.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (22 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918334381106676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918334381106676