Medicaid Managed Care: Expenditures, Screening of Providers, and Utilization Patterns


Geneva Barrett (Editor)

Series: Health Care in Transition
BISAC: LAW046000

The importance of managed care in Medicaid—under which states contract with managed care organizations (MCOs) to provide a specific set of services—has increased as states expand eligibility for Medicaid under the Patient Protection and Affordable Care Act (PPACA) and increasingly move populations with complex health needs into managed care. States have flexibility within broad federal parameters to design and implement their Medicaid programs, and therefore play a critical role in overseeing managed care. This book analyzes federal expenditures for Medicaid managed care and the range in selected states’ payments made to MCOs; selected states’ medical loss ratio (MLR) standards and how they compare with federal standards for other sources of health coverage; and selected states’ methods for automatically assigning Medicaid beneficiaries to MCO plans. Furthermore, this book examines states’ and plans’ experiences using federal databases to screen providers; and how states and plans share data about ineligible providers. (Imprint: Novinka)

Table of Contents

Table of Contents


Chapter 1. Medicaid Managed Care: Trends in Federal Spending and State Oversight of Costs and Enrollment
United States Government Accountability Office

Chapter 2. Medicaid Program Integrity: Improved Guidance Needed to Better Support Efforts to Screen Managed Care Providers
United States Government Accountability Office

Chapter 3. Medicaid: Service Utilization Patterns for Beneficiaries in Managed Care
United States Government Accountability Office


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