A guide for child health advocates: Medicaid managed care accountability through transparency
- Collection:
- Health Policy and Services Research
- Author(s):
- Schneider, Andy, author Corcoran, Allie, author Hurler, Emma, 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, July 2021
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Child Health Managed Care Programs Medicaid Pregnant Women 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—over 35 million at last count—and pays for nearly half of the nation’s births. It offers a comprehensive pediatric benefit—Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services—for children and comprehensive maternity care for pregnant women. In most states, Medicaid agencies contract with managed care organizations (MCOs) to organize networks of providers to deliver covered services to most, if not all, Medicaid-eligible children and pregnant women. As of July 2021, 40 states and the District of Columbia contracted with a total of 287 MCOs to manage services for Medicaid beneficiaries; in almost all of those states, most eligible children are enrolled in MCOs. Total federal and state Medicaid spending on MCOs this year is projected to be in the neighborhood of $300 billion. How well those 287 MCOs perform determines how good Medicaid coverage is for the children and pregnant women they enroll. And because children and pregnant women eligible for Medicaid are disproportionately people of color, how well MCOs perform will largely determine how effectively the Medicaid program addresses racial and ethnic health disparities. If an MCO is a high-performing organization, Medicaid coverage can improve their health outcomes. If the MCO is a low-performing organization, Medicaid coverage will have little or no value. So how can we know whether an individual MCO is high- or low-performing? How transparent are state Medicaid agencies and MCOs about their performance for children and pregnant women? And if performance information is publicly available, how can advocates use it to identify low-performing MCOs and hold them accountable? The purpose of this Guide is to help child and maternal health advocates use transparency to hold MCOs accountable for their performance for children and pregnant women. Transparency is not the only tool for holding MCOs accountable—administrative advocacy, legislative oversight, and litigation are also available—but it has the advantage of imposing no new costs on the state treasury and no significant administrative burden on either the MCOs or the state agency. MCOs are already being paid to manage care and report to the state agencies on their performance; state agencies are already reviewing this information to assess the accessibility and quality of care Medicaid beneficiaries are receiving from the MCOs they are paying. Transparency simply requires that this information be made publicly available so that all stakeholders—beneficiaries, providers, state policymakers, investors, and the public at large—can know which MCOs are performing at a high level and which are not.
- 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 (14 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918334381506676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918334381506676