Two recent reports found that Medicaid managed care plans now
enroll most Medicaid members, help keep costs and premiums low in the markets
where they participate, and are competitive with commercial plans at the low
end of the individual market in areas including network quality and benefit
design.
One white paper was prepared by consultancy The Menges Group for
America's Health Insurance Plans (AHIP), and the other was authored by
researchers at the Robert Wood Johnson Foundation (RWJF) and Urban Institute.
The Menges Group-AHIP white paper, which had a national scope,
found that Medicaid MCO enrollment increased by 121% between fiscal years 2010
and 2018, from 26 million to over 56 million members, and that as of 2018, more
than 75% of all Medicaid enrollees are members of an MCO, up from 50% in 2010.
The report also found that, since 2017, capitated payments to MCOs have
exceeded fee-for-service expenditures.
The RWJF-Urban Institute paper, which relied on case study
surveys in Arkansas, California, Florida, New York, Ohio, and Washington state,
concluded that MCOs offer coverage that is at least as good as commercial plans
in the low end of the Affordable Care Act individual market.
"Many [stakeholders] feel there are no longer major
distinctions between Medicaid and commercial insurers in the marketplaces. Most
interviewees have positive perceptions of Medicaid insurers, crediting their
ability to increase choice and affordability in the individual health insurance
market," wrote the paper's authors.
Most of the surveyed stakeholders, which the paper says
"included representatives from state departments of insurance, hospital
associations, medical or primary care provider associations, insurance brokers,
and consumer advocates," believe that Medicaid MCOs have improved the
level of competition in their state marketplace, and offer their members
similar network quality to commercial plans.
From
Health Plan Weekly
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