Through the Affordable Care Act, in 2013 and 2014, Medicaid is required to reimburse primary care providers at parity with Medicare rates -- a "bump" that is funded 100 percent by the federal government. This increase in Medicaid provider rates offers a potentially powe... more
State Medicaid programs can contract directly with Medicaid managed care organizations (MCOs) to deliver health services to enrollees, with MCOs currently covering 69 percent of all Medicaid enrollees nationally. These organizations and their provider networks can be im... more
Medicaid is rapidly becoming every state's largest health insurer, and with that status comes an increasing focus on Medicaid's payment policies. Yet to date, Medicaid payment reform initiatives have largely neglected to address a significant component of Medicaid payme... more
A growing number of states are planning, implementing, or expanding Medicaid managed care programs for people with disabilities. In choosing program features, states are faced with a wide array of potential options. One design element that has critical implications for ... more
ER Connect is a cloud-based solution that is designed to streamline information exchange and facilitate direct referrals. Information exchange falls into three types: Hospital discharges – helping uninsured and Medicaid patients establish continuity of care with ... more
Many of Medicaid’s 52 million beneficiaries are members of racial and ethnic subgroups, and over 60 percent of them are enrolled in managed care. By virtue of the diverse populations enrolled, Medicaid health plans are uniquely positioned to identify and address dispa... more
State Medicaid agencies are increasingly pursuing opportunities to address health-related social needs (HRSN) to improve health outcomes, reduce health care spending, and advance health equity. These efforts are accelerating in the current environment due to the COVID-1... more
What is care management? States participating in CHCS' Managed Care for People with Disabilities Purchasing Institute -- California, Indiana, Nevada, New York, Pennsylvania, and Washington -- sought to answer this question and to consistently define the essential requir... more
The Best Clinical and Administrative Practices (BCAP) Quality Framework offers a systematic approach to improve quality within Medicaid managed care. Managed care organizations using the model are able to effectively target quality improvement resources and produce meas... more
