Managed Care is a health care delivery system organized to manage cost, utilization, and quality. Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCOs) that accept a set per member per month (capitation) payment for these services. Every state uses some form of managed care, and in recent years, more states have expanded managed care services, including to serve people with IDD. Though there is promise in cost-savings and building efficiency, it is vital that providers be included in the design of any managed care system.
In 2016, the Centers for Medicare and Medicaid Services (CMS) issued a final rule with regulations designed to support state efforts to advance delivery system reform and improve the quality of care, strengthen the beneficiary experience of care and key beneficiary protections, strengthen program integrity by improving accountability and transparency, and align key Medicaid and CHIP managed care requirements with other health coverage programs.
Medicaid Managed Care Final Rule (issued May 6, 2016)
ANCOR Principles of Managed Long Term Services and Supports (September 5, 2014)