33 States Report 75% Medicaid Managed Care Penetration Rate

Among the 40 states with Medicaid managed care organizations (MCOs), 33 reported that at least 75% of their Medicaid beneficiaries were enrolled in MCOs during 2019. In that year, 21 states set a target percentage of MCO payments, or covered lives, that must be in alternative payment models (APMs). Three additional states plan to do so in fiscal year 2020.

Nineteen states reported requirements for minimum reimbursement rates in their MCO contracts for physicians in inpatient hospitals, outpatient hospitals, or primary care. Seventeen states reported requiring MCOs to change payment rates in accordance with fee-for-service payment rate changes . . .