MACPAC finds growth in Medicaid managed care

About 71% of Medicaid enrollees are now enrolled in managed-care programs as states sharply increased their use of the money-saving design variation in recent years, according to the first report of the extent of managed care by the Medicaid and CHIP Payment and Access Commission.

The first assessment of Medicaid and the Children’s Health Insurance Program’s use of managed care since MACPAC was formed by the Children’s Health Insurance Program Reauthorization Act of 2009 found managed care use has grown quickly in recent years. For example, enrollment in comprehensive risk-based plans—the dominant type of managed care—increased to 47% of Medicaid enrollees in 2009 from 15% in 1995.

Despite the growing use of managed care by states looking to reduce the growing cost of the state-federal program, the report noted, managed care accounted for only 21% of its total spending because the most costly enrollees are not included in those programs. The bulk of managed-care enrollees are nondisabled children, while only about 28% of costly enrollees with disabilities are in comprehensive risk-based managed care plans, for example.

“Given the complex healthcare needs and the limited personal resources of Medicaid populations, it is critical to understand the role that managed care plays in delivering care and improving quality for this population,” Diane Rowland, chairwoman of the commission, said in a written statement.

The congressional advisory panel issued a broader overview of Medicaid and CHIP in March.

Although its authorizing legislation also required the June report to issue recommendations for changes to the programs, the report did not include any. MACPAC leaders were not available for comment Wednesday afternoon.