Medicaid managed care: Improving outcomes, enhancing access and managing costs

Medicaid managed care organizations (MCOs) play an important role in delivering high-quality, cost-effective health care to millions of individuals across the country. By increasing access to essential services, improving the consumer experience and managing costs effectively, MCOs help consumers, state partners and providers alike.

Medicaid provides coverage to individuals who might otherwise be uninsured while also acting as a payer for health care providers. A majority of states have adopted a Medicaid managed care (MMC) model, with 45 states utilizing MMC for some or all Medicaid populations and benefits.¹ The most common structure is a comprehensive risk-based arrangement, where states pay MCOs a fixed monthly amount per member to deliver available services, transferring financial risk to the MCOs. This model allows for tailored programs that address the specific needs of diverse populations while simultaneously reducing costs and improving health outcomes.

The following report provides a detailed account of the Medicaid landscape, examining its impact at both the state and national levels.