Soon-To-Be Released Medicaid Managed Care Regs Likely To Be ‘Epic’
Stakeholders are watching carefully for the regulations, the first such rules issued by the federal government in more than a decade, because states have increasingly been moving toward this managed care model for the federal-state low-income health insurance program.
National Journal:
New Medicaid Rules Could Be ‘Epic’
Some time very soon, the Obama administration is going to propose federal regulations for Medicaid managed care for the first time since 2002. It is, in the immortal words of Vice President Joe Biden, a BFD within this world, where upwards of 40 million Americans receive health coverage through Medicaid that is administered by private insurers. The rules could touch almost every area of managed care, which pays plans on a per-member basis instead of the traditional fee-for-service that just pays for each procedure, test, office visit, and so on. (Scott, 5/14)
St. Louis Post-Dispatch:
More Managed Care, More Problems?
Around the country more and more states are shifting to the managed care model. It differs from traditional Medicaid in that a private corporation receives a flat amount from the state to manage and pay for various aspects of a recipient’s care. Under traditional Medicaid, the state directly reimburses providers for each test and treatment. The managed care Medicaid model has been in Missouri for about 20 years. But it only applied to children and parents who lived in 54 counties concentrated along Interstate 70. Recipients who are currently on managed care account for about half of the state’s roughly 850,000-strong Medicaid population. (Shaprio, 5/15)
