Tag Archives: risk-based managed care

Report explores Medicaid managed care programs

Today, nearly every Medicaid state agency uses some form of managed care. The form that accounts for the majority of Medicaid enrollment coverage is risk-based managed care, with approximately two out of every three members enrolled with a comprehensive managed care health plan. Risk-based managed care is the mechanism in which Medicaid recipients receive healthcare benefits, at least in part, in 38 or more states in the United States, the District of Columbia, and Puerto Rico.

The introduction of the Medicaid expansion population in 2014 generated substantial increases in Medicaid beneficiaries, although enrollment levels are beginning to flatten out or even decrease in certain programs. The enrollment stabilization seen in recent years will likely be disrupted by the enrollment increases attributable to the COVID-19 pandemic during calendar year (CY) 2020, although the full impact on Medicaid enrollment is not yet known.

This report by Milliman’s Jeremy Palmer, Chris Pettit, and Ian McCulla summarizes CY 2019 experience for selected financial metrics of organizations reporting Medicaid experience under the Title XIX Medicaid line of business on the National Association of Insurance Commissioners (NAIC) annual statement.