Feds Issue New Rules for Medicaid Managed Care Programs

The Obama administration tightened rules Monday for private insurance plans that administer most Medicaid benefits for the poor, limiting profits, easing enrollment and requiring minimum levels of participating doctors. (Kaiser  Health News)

Medicaid managed care services are offered by risk-based managed care organizations, which contract with state Medicaid programs to offer care to enrollees. Essentially, they are the private insurer alternative to traditional fee-for-service Medicaid. (Morning Consult)

Among other requirements, the rules specify that insurance companies must guarantee access to certain types of service providers, and that at least 85 percent of what insurers get paid must be spent on medical care. They also envision a quality rating system to help Medicaid recipients pick a plan. (ABC News)

“Today’s final rule has four goals: supporting states’ efforts to advance delivery system reform; strengthening the consumer experience of care; strengthening program integrity; and aligning rules across health insurance coverage programs to improve efficiency and help consumers,” said Vikki Wachino, MPP, director for the Center for Medicaid and CHIP Services at CMS. (MedPage Today)

What is a Medicaid Managed Care Plan?