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 important partners in the adoption and delivery of the evidence-based interventions included in the Centers for Disease Control and Prevention’s (CDC) 6|18 Initiative. In particular, MCOs have more flexibility than feefor-service Medicaid to cover certain health services — including disease management strategies and community-based programs. States are also increasingly providing MCOs financial incentives to improve population health and keep members healthy, further motivating MCOs to invest in evidence-based prevention efforts. MCOs are especially willing to cover prevention benefits when the state presents clear evidence that coverage is associated with improved health outcomes and a positive return-on-investment.
This technical assistance tool outlines how states can partner with Medicaid managed care organizations (MCOs) to implement evidence-based prevention interventions under the Centers for Disease Control and Prevention’s (CDC) 6|18 Initiative for one or more high-burden, high-cost health conditions — tobacco use, high blood pressure, inappropriate antibiotic use, asthma, unintended pregnancies, and type 2 diabetes.