Medicaid Managed Care
Expert articles and analysis related to medicaid managed care.
AI Summary — Last 7 Days
Medicaid managed care pressure is intensifying as states, plans, and safety-net providers face tighter oversight, uneven rate adequacy, and new eligibility compliance risk: Elevance’s planned exit from D.C. Medicaid and review of additional markets signal that some MCOs see current Medicaid economics as unsustainable even as enrollment and acuity remain volatile (Healthcare Dive). At the same time, the Trump administration’s HHS/CMS fraud and program-integrity posture, Medicaid work requirement implementation questions, and scrutiny of CMMI’s ACCESS behavioral health model are raising the operational stakes for VBC stakeholders that depend on stable attribution, care-management funding, and FQHC/behavioral health participation (Becker’s Behavioral Health). The emerging pattern is a Medicaid VBC market caught between policy ambitions—primary care investment, behavioral health integration, SUD waiver flexibility, and FQHC value-based opportunities—and payer/provider concerns that payment levels, compliance burdens, and state-by-state variability could undermine participation.
Related Articles
Medicaid managed care: An Explainer
A paper by Mark Shepard and Jacob Wallace (2026) has a great overview of the Medicaid managed care program. The first question one may have is, how does Medicaid managed care differ from other forms o...
Navigating State Variability in Medicaid Work Requirements
Oregon Medicaid Launches Nutrition Benefits For Members With Complex Health Conditions - open minds
Oregon Medicaid Launches Nutrition Benefits For Members With Complex Health Conditions open minds
A Profile of Dual-Eligible Individuals
Approximately 12 million people are enrolled in both Medicare and Medicaid, referred to as dual-eligible individuals. This brief examines the demographic, socioeconomic, and health characteristics of ...
Five Key Facts About Spending and Enrollment for People with Medicare and Medicaid (Dual-Eligible Individuals)
This issue brief analyzes provides a profile of enrollment and spending on dual-eligible individuals, drawing on new analysis of data on chronic conditions to show how higher rates of chronic conditio...
Elevance shuts down D.C. Medicaid business, eyes additional exits after passable Q2
Elevance will leave D.C. this summer and is considering other markets to depart, executives said. The company outperformed Wall Street expectations in the second quarter — but not by much, and its sto...
New Federal Pharmacy Demonstrations: Key Considerations for Medicaid Decision-Makers
New Federal Pharmacy Demonstrations: Key Considerations for Medicaid Decision-Makers Center for Health Care Strategies
Managed Care as Medicaid’s Administrative Architecture: Does It Still Provide Value to States?
Managed Care as Medicaid’s Administrative Architecture: Does It Still Provide Value to States? Milbank Memorial Fund
Access in Brief: Children’s Use of Behavioral Health Services - MACPAC - Advising Congress on Medicaid and CHIP Policy (.gov)
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26 States Sue To Block Medical Frailty Provisions In Interim Medicaid Work/Community Engagement Rules - open minds
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