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A Look At The Numbers
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Medicaid and COVID-19

The COVID-19 pandemic has triggered an unprecedented health and economic crisis in the United States.

Medicaid was already a lifeline for over 71 million Americans, and as more people face unemployment or changing economic circumstances, more individuals will become eligible for Medicaid. Estimates suggest that Medicaid enrollment could increase by as much as 10.6 to 23 million people over the coming months.1

Future of Medicaid managed care

Medicaid is at its best in partnership with managed care organizations (MCOs). MCOs ease the burden on states, combining the innovation and speed of private industry with the accountability and oversight of government. All of this while managing costs and keeping quality high. Now and into the future, managed care is the right partnership.

Managed care organizations

The positive role of MCOs

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States across the country are facing a unique healthcare challenge, and managed care organizations are here to help. Medicaid managed care enables states to deliver higher quality care, improve health outcomes of Medicaid recipients, and manage healthcare costs. In total, nearly three-quarters of all Medicaid enrollees in the U.S. receive care through MCOs, representing nearly 50 million Americans.2

50M

Americans receive care through MCOs2

COVID-19 challenge

How MCOs are helping

Now more than ever, Medicaid is playing a critical role supporting the health and well-being of millions of Americans. States across the country are expanding Medicaid benefits to increase access to critical COVID-19 testing and treatments. MCOs are helping states manage and respond to COVID-19 by:

  • Expanding telehealth offerings
  • Conducting proactive outreach and providing information to those most at-risk for the virus
  • Ensuring individuals have the medications they need

MCOs are working with local community groups to address social determinants of health by coordinating and distributing food, providing housing support, and making referrals to social services and other government programs.

To support the provider network during the pandemic, MCOs are providing advanced payments and education resources, and advocating for federal action, such as the responsible distribution of relief funds to providers who are most in need.

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33

states in the U.S. report that more than 75% of their Medicaid beneficiaries are enrolled with MCOs3

Managing costs and risks

Delivering benefits and predictability

With a growing number of Medicaid applications and an urgent need for COVID-19 related care, MCOs help states better plan and manage their budget. MCOs accept a fixed payment for services per member per month from the state. With this model, state partners know how much of their budget they will need to allocate on Medicaid spending based on enrollment.

$7.1B

in nationwide Medicaid savings in 20164

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Higher quality care

The right model for the long term

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MCOs are held to high standards at both the federal and state level, and work closely with their state Medicaid partners to achieve quality health outcomes for those they serve. MCOs in nearly every state are accredited and regularly reviewed by the National Committee on Quality Assurance (NCQA). MCOs are held accountable for up to 69 quality measures each year by the NCQA.5

Governments that combine public resources, accountability, and oversight with private sector expertise are better positioned to provide quality healthcare to their citizens, both now and in the long term.

75%

of MCO states report using chronic disease management metrics when rewarding or penalizing plan performance6

Coordinated care

Addressing social determinants

MCOs can serve as the glue that binds community resources with a unified health strategy, integrating physical and mental health services. In 2018, 78% of all MCOs offered programs targeting social determinants, including 100% of large health plans.7 During the COVID-19 pandemic, MCOs are continuing to closely partner with and support local community groups that address social determinants of health. Services that MCOs are supporting include:

  • Coordination and distribution of food (outside of standard meal programs)
  • Housing support
  • Referrals to social services and other government programs such as SNAP and WIC
  • Expanding access to technology (e.g., Federal Lifeline program, etc.)
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100%

of large Medicaid MCO health plans offered targeted programs in 20187

Citations

1 https://www.spglobal.com/marketintelligence/en/news-insights/latest-news-headlines/medicaid-enrollment-may-surge-as-pandemic-takes-toll-on-us-economy-57950030
2 https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-managed-care
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
6 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/
7 https://www.medicaidinnovation.org/_images/content/2019_Annual_Medicaid_MCO_Survey_Results_FINAL.pdf

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.