Modernizing Medicaid managed care
The “mega” Medicaid managed care rule released in the spring of 2016 by the Centers for Medicare and Medicaid Services (CMS) set in motion a long-overdue overhaul of managed care programs in Medicaid and the Children’s Health Insurance Program. As managed care plans oversee larger percentages of enrollees and benefits, the pressure on state Medicaid agencies to ensure that those plans are providing quality services for a good value increases, as does the need to ensure program integrity is maintained.
The Medicaid managed care rule improves beneficiary protections, increases the focus on quality of care, strengthens financial management and program integrity efforts, and provides states with support for delivery and payment system reform efforts within managed care (e.g. value-based purchasing). In addition, this rule strengthens data submission and reporting requirements to support program oversight, program integrity, and increased transparency.