Top Resources on Medicaid Managed Care Library


Welcome to the OPEN MINDS Top Resources on Medicaid Managed Care Library. Our team of researchers and industry analysts have carefully chosen a selection of articles, presentations, reports, and statistics related to Top Resources on Medicaid Managed Care. These resources will provide all of the essential market intelligence your team needs.

Top Resources on Medicaid Managed Care

As selected by the OPEN MINDS Market Intelligence Team

  • North Carolina Legislature Approves Medicaid Reform, Behavioral Health Carve-Out To End

    News Report | December 20, 2015
    On September 23, 2015, North Carolina Governor Pat McCrory signed Medicaid reform legislation that will end the state’s behavioral health carve out. The reform legislation calls for the North Carolina Department of Health and Human Services (DHHS) to contract...
  • How One Medicaid Plan Is Letting The Data Do The Talking

    Executive Briefing | November 4, 2015
    There is a lot of measurement going on in health and human services – but is that data being used to shape policy? The answer to that question is “yes,” if you’re with the Medicaid program in Pennsylvania. David K. Kelley,...
  • Dual Eligible Demonstrations – What States Are Moving Ahead?

    Executive Briefing | October 23, 2015
    In 2012, the Centers for Medicare and Medicaid Services (CMS) began approving state dual eligible demonstration projects, with the first demonstration launching in July 2013 (see Where Are The Dual Eligible Demonstration Projects?). Last summer, CMS announced that states...
  • Which States Provide Medicaid Long-Term Services & Supports Through Managed Care?: An OPEN MINDS Market Intelligence Report

    Market Intelligence Report | October 16, 2015
    Long-term services and supports (LTSS) refers to care provided to individuals with functional limitations and chronic illness who need help completing activities of daily living. Activities of daily living refers to activities such as bathing, dressing, preparing meals, and...
  • The Landscape Of Behavioral Health Carve-Ins

    Executive Briefing | September 2, 2015
    One of the biggest changes in the past five years, in the name of “integration,” has been the demise of primary behavioral health carve-outs in Medicaid. There are six states that are currently planning to end their Medicaid primary behavioral health...
  • Iowa Selects Amerigroup, AmeriHealth Caritas, UnitedHealthcare & WellCare For Medicaid Integrated Physical & Behavioral Health Contracts

    News Report | August 23, 2015
    On August 17, 2015, the Iowa Department of Human Services (DHS) announced it had selected proposals submitted by Amerigroup Iowa, Inc.; AmeriHealth Caritas Iowa, Inc.; UnitedHealthcare Plan of the River Valley, Inc.; and WellCare of Iowa, Inc. for Medicaid...
  • Washington State To Move Medicaid Addiction Treatment To Managed Care & Carve-In Mental Health Services

    News Report | August 23, 2015
    The Washington State Health Care Authority (HCA) is preparing to integrate Medicaid mental health and addiction treatment services into its physical health managed care plans by 2020. As a first step, on August 6, 2015, HCA released a request...
  • Carve-Out Or No

    Executive Briefing | July 30, 2015
    The primary carve-out model of financing and managing behavioral health services is on the wane. In a number of states – the primary behavioral health carve-out in Medicaid has either been replaced (New Mexico and Oregon), or is in the process of...
  • California & The Mental Health Carve-Out

    Executive Briefing | July 28, 2015
    Last week, OPEN MINDS Market Intelligence Analyst Athena Mandros gave a great overview of all the many changes happening in California’s Medicaid program (Medi-Cal) and discussed why it’s important for other states to keep an eye on California’s system...
  • Nebraska Medicaid To End Behavioral Health Carve-Out, Effective July 1, 2017

    News Report | August 16, 2015
    As of July 1, 2017, Nebraska's Medicaid program will be reformed to include both physical and behavioral health in its Medicaid health plans, eliminating the behavioral health carve-out. The state plans to release a request-for-proposal (RFP) for three managed...
  • Colorado Medicaid To End Behavioral Health Carve-Out

    News Report | May 31, 2015
    On July 1, 2017, Colorado plans to integrate physical health and behavioral health services for Medicaid beneficiaries enrolled in the Accountable Care Collaborative (ACC) by contracting with a single administrative entity to deliver all Medicaid services. Currently, physical health...
  • The Brave New World Of SMI Population Management – New Care Coordination Model, New Financing Model

    Executive Briefing | February 16, 2015
    Over the past two years, there has been lots of discussion about “integration” and we have covered the emerging range of integrated care coordination models – the growth of Medicare SNPs (see Medicare Advantage Enrollment Up 9% Between 2011 &...
  • 2013 Medicaid Managed Care Enrollment Report

    Industry Resource | December 31, 2015
    The Centers for Medicare & Medicaid Services (CMS) has released its annual update composed by the Data and Systems Group (DSG) on Medicaid managed care enrollment. The report profiles Medicaid managed care programs on a plan-specific basis as of...
  • Alabama Medicaid Certifies 11 Probationary Regional Care Organizations In Shift To Risk-Based Care

    News Report | January 11, 2015
    On December 31, 2014, the Alabama Medicaid Agency (AMA) announced that 11 health care provider organizations had been certified as probationary Medicaid Regional Care Organizations (RCOs). The RCOs are part of Alabama’s Medicaid 1115 demonstration waiver to shift its...
  • 66% Of All Medicaid Beneficiaries Enrolled In Managed Care Plans In 2014

    News Report | February 1, 2015
    In 2014, about 66% of Medicaid beneficiaries, or 43.5 million of the total 66.5 million beneficiaries for that year, were enrolled in a Medicaid managed care plan run by one of 184 private health insurers. The percentage of Medicaid...
  • OIG Report On State Standards for Access to Care in Medicaid Managed Care (OEI-02-11-00320)

    Industry Resource | September 29, 2014
    In September 2014, the federal Office of the Inspector General (OIG) issued a report (OEI-02-11-00320) evaluating the adequacy of access to care for enrollees in Medicaid managed care. This report describes the standards that states establish for access to...
  • Which States Carve Behavioral Health Benefits Out Of Medicaid Managed Care Contracts?

    Market Intelligence Report | June 20, 2014
    A carve-out is a Medicaid financing model where some portion of Medicaid behavioral health benefits— mental health outpatient, psychiatric inpatient, addictions, pharmacy, etc. —is separately managed and/or financed on an at-risk basis by another organization or retained by the...
  • What Share Of The Dual Eligible Population Is Served In Managed Care?

    Market Intelligence Report | May 7, 2014
    Dual eligibles are Medicare enrollees who also receive some form of assistance from their state Medicaid program. Since CMS’ last Medicaid enrollment report for 2011, at least 34 states either implemented or planned new initiatives to better coordinate care...
  • What Services Are Included In The Capitated Rates Paid To Managed Care Programs Participating In The CMS Dual Eligible Demonstration Projects?

    Market Intelligence Report | March 11, 2014
    The Centers for Medicare & Medicaid Services (CMS) launched state demonstrations to integrate care for dual eligible individuals in April 2011 in an effort to expand access to integrated programs for full benefit dual eligibles. Full dual eligibles meet...
  • How Are Medicaid Long-Term Services & Supports (LTSS) Covered & Delivered?

    Market Intelligence Report | March 14, 2014
    The Centers for Medicare and Medicaid Services (CMS) defines long term services and supports (LTSS) as the services and supports used by individuals with functional limitations and chronic illnesses who need assistance to perform routine daily activities. This includes...
  • Information Technology Key To Managed Medicaid Long-Term Care

    News Report | February 10, 2014
    Information Technology Key To Managed Medicaid Long-Term Care Medicaid officials in states that were early adopters of managed long-term services and supports (LTSS) said that robust information technology systems were key to supporting care coordination processes and adequate access...
  • Improper Payment Rates For Medicaid & Medicare Managed Care Plans Lower Than In Fee-For-Service Plans

    News Report | January 20, 2014
    Improper Payment Rates For Medicaid & Medicare Managed Care Plans Lower Than In Fee-For-Service Plans During federal fiscal year (FFY) 2013, the national improper payment rates in the Medicaid and Medicare programs were lower for managed care than for...
  • Preparing For Value-Based Contracting: The OPEN MINDS Toolkit

    Executive Briefing | May 11, 2013
    Across the wide range of stakeholders in the health and human service field, most want to see an end to fee-for-service (FFS) reimbursement. What comes next is yet to be defined – but there are a range of pay-for-performance...
  • MACFacts: Medicaid Managed Care

    Industry Resource | April 25, 2013
    On April 25, 2012, the Medicaid and CHIP Payment and Access Commission (MACPAC) released a report containing descriptions of the different types of Medicaid managed care arrangements, a brief history of managed care in Medicaid, and the most recent...
  • Medicaid Managed Care Toolkit

    Executive Briefing | March 13, 2013
    Medicaid managed care has shaped up to be one of the primary disruptive influences in the health and human services industry today. And, states are expanding the use of managed care to address new populations, and populations from different...
  • Medicaid In The Child Welfare System: A Medicaid Managed Care Toolkit

    Feature Article | September 1, 2012
    Medicaid In The Child Welfare System: A Medicaid Managed Care Toolkit On any given day, there are close to half a million children in foster care in the U.S. Many more come to the attention of the child welfare...
  • Trends In Managed Care Contracting: 2001–2010

    Feature Article | January 1, 2013
    Trends In Managed Care Contracting: 2001–2010 Over the first decade of the 21st century, the role of risk-based managed health care for publicly insured beneficiaries has expanded substantially. This report examines this form of health care delivery in 20...
  • Promising Medicaid Innovations In Purchasing, Populations & Organization

    Feature Article | October 1, 2012
    Promising Medicaid Innovations In Purchasing, Populations & Organization The Massachusetts Medicaid Policy Institute, a program of the Blue Cross Blue Shield of Massachusetts Foundation, engaged the Center for Health Care Strategies (CHCS) to conduct a national environmental scan to...
  • What States Are Doing To Bend The Cost Curve

    Executive Briefing | September 11, 2012
    The focus of yesterday’s briefing was why “bending the cost curve” is an inevitable occurrence in the U.S health and human services system (see No Matter the Politics, “Bending The Cost Curve” Here to Stay all members) – and...
  • Medicaid And CHIP Risk-Based Managed Care In 20 States: Experiences Over The Past Decade And Lessons For The Future

    Industry Resource | July 1, 2012
    In July 2012, the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services (ASPE) released a final report prepared by the Urban Institute on health care delivery in 20 states for both...
  • “Managed Behavioral Care” Evolves

    Executive Briefing | March 22, 2012
    The models for applying managed care principles to the financing and delivery of mental health and addiction treatment services have been through thirty years of evolution. There have been many incarnations of care management for behavioral health – from...
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