The 2016 OPEN MINDS Medicaid Managed Care Update: A State-By-State Analysis

In understanding the impact of Medicaid and Medicaid managed care in any state, there are three key elements: the financing mechanism, the services provided, and the populations that are included. Generally, there are three financing mechanisms for the delivery of Medicaid benefits: fee-for-service (FFS), primary care case management (PCCM), and managed care. These financing systems vary by state, consumer population, and payer.

Typically services provided are broken into two categories: health care services and long-term services and supports (LTSS). And, there are three main population groups: the Medicaid-eligible population, the Medicaid-eligible population also eligible for LTSS, and the Medicare-Medicaid dual eligible population.

It is of note that the percentage of Medicaid beneficiaries in managed care has changed dramatically since 2010 when only 49% of the Medicaid population was enrolled in managed care (an increase of 18.8% in six years). Managed care delivery models generally are structured to provide a capitated payment to health plans to provide services to Medicaid enrollees.

In this OPEN MINDS Market Intelligence Report, we analyze the Medicaid financing mechanisms by state, by population, and by service mix. This report provides detail on how services are provided to the broad range of Medicaid eligible beneficiaries on a state-by-state basis. The report is structured in three sections:

• The Medicaid population in managed care including historical enrollment data
• Medicaid managed care enrollment, FFS enrollment, and PCCM enrollment by state
• The Medicaid population enrolled in plans for dual eligibles

This report is the first in a series of annual updates that will be published by OPEN MINDS through primary research and original analysis. This annual report will serve as a state-by-state guide to the Medicaid managed care market.