Helping people get healthcare

This site provides information on how managed care organizations (MCOs) partner with states to administer Medicaid benefits. Now more than ever, there is a critical need to provide quality care to a growing Medicaid population and to help states better plan and manage their budgets. When facing these challenges, managed care is the right partnership.

Learn about COVID-19 and Medicaid

What is Medicaid?

Medicaid is a federal and state program that provides healthcare coverage to qualified individuals. Under federal regulations, states create and oversee a Medicaid managed care program that best serves their residents. States may choose to provide more services or coverage to people than is required.

History

A history of Medicaid

1965
Medicaid is established¹
1997
Children’s Health Insurance Program (CHIP) is created¹
2019
Medicaid and CHIP cover 71 million people²

Who Medicaid covers

71M

Medicaid provides coverage for over 71 million people²

Medicaid serves certain people experiencing low incomes, including pregnant women, children (including those in foster care), and seniors. Medicaid also serves people with disabilities.

States may choose to expand eligibility to additional groups. Individuals eligible for Medicaid must meet certain Federal Poverty Level (FPL) eligibility thresholds.

How Medicaid works

A federal and state partnership

States create and run a Medicaid program based on federal requirements to serve people in their state. States may also choose to provide more services or cover more of the population than is required.

The federal government has requirements that all states must follow when running Medicaid programs and also provides at least 50% of the funding for these programs.

States may contract with MCOs to deliver coverage.

75%

of people in 33 states are enrolled in Medicaid with MCOs³

The value of Medicaid managed care

Medicaid managed care enables states to deliver higher quality care, improve health outcomes of Medicaid recipients, and manage healthcare costs.

With the costs of healthcare rising, managed care allows states to better control cost trends and budget with predictability. The managed care model delivered nationwide Medicaid savings of $7.1 billion in 2016.⁴

MCOs coordinate care to ensure the delivery of efficient, quality care that people need, when they need it.

quality measures that MCOs are accountable for annually⁵

Downloads

About Nationwide Medicaid Managed Care pdf 175 KB

Citations

¹ https://www.cms.gov/About-CMS/Agency-information/History/
² https://www.kff.org/health-reform/state-indicator/total-monthly-medicaid-and-chip-enrollment/
³ https://www.kff.org/medicaid/report/a-view-from-the-states-key-medicaid-policy-changes-results-from-a-50-state-medicaid-budget-survey-for-state-fiscal-years-2019-and-2020/
⁴ The Menges Group, 2017
⁵ http://healthinsuranceratings.ncqa.org/2019/Default.aspx

A Look At The Numbers is an educational resource about Medicaid managed care, hosted and supported by Medicaid Health Plans of America, in collaboration with other Medicaid managed care organizations and state health plan associations.