Medicaid managed care is a health insurance coverage that covers almost 75 million low-income Americans. The federal government has given the authority to states to cover certain services among specific populations according to their eligibility. This means the coverage provided through Medicaid-managed care varies from state to state.
If you get yourself enrolled in a health plan, then there are four health plans that you have to opt from. Since 1990, the share of Medicaid enrollees has dramatically increased.
To know the details of Medicaid managed care, we have divided the term into its types and structure.
Types of Medicaid managed care
PCCM (Primary care case management)
In PCCM, states offer contracts with hospitals and primary care providers to provide the need-based services for the enrollees of Medicaid-managed health plans. These primary care providers receive monthly management fees from the states to provide coordinated care additionally with the fee-for-service payments.
Comprehensive risk-based managed care
Comprehensive risk-based managed care is one of the common and well-known types of Medicaid managed care. According to the data available, around 69% of the enrollees had this kind of plan in 2017 in the United States. In this type, states hold an agreement with the managed care organizations (MCOs) to offer enrollees to have a full package of health plan benefits.
Limited benefit plan
In a limited plan, states sanction a limited payment generally agreeing with the MCOs to provide limited benefits to the enrollees. However, limited health plans cover high-rated mental disorders and behavioral issues instead of providing a range of different health services.
Why is Medicaid managed care growing?
To manage the cost of health insurance plans, MCOs strive to keep the quality in all the services instead of going to have several services that usually people don’t take, such as hair transplantation and surgical repairs, etc. which is particularly known as a value-based payment model. MCOs also focus on implementing food and health security services for every fifth of Americans.
Expanding Medicaid population
Previously, Medicaid managed care management was limited to only pregnant women and children but as time passes, MCOs have brought up significant changes in the agreements and have expanded its availability to everyone who is in need regardless of any gender and age.
Services that are not needed by the enrollees incur an extra cost for states in the name of fee-for-service payments. In the light of the cost-effective strategies brought about by managed care MCOs, states are relying on maintaining the budget for the arrangements of services and Medicaid-managed care.
How does it work?
Medicaid-managed care is financed by both the federal government and the state government. The federal government is committed to paying states for the fee-for-service. The share that every state gets from the federal government depends on the per capita income; however, every state must get the share of 50% of their needs as a federal reimbursement.
In 2018, the cost that was spent by Medicaid was $616 billion of which $230 billion was paid by the states, and the rest of the amount was covered by the federal government.