Medicaid and CHIP Risk-Based Managed Care in 20 States. Experiences Over the Past Decade and Lessons for the Future.. Medicaid Plans.


Figure 6shows the distribution of the Medicaid MCOs in study states, according to these two criteria. (State-by-state detail is provided in Appendix B, Table 4.) The dominant type of plan serving Medicaid risk-based managed care enrollees in the study states is a nonprofit plan that serves only publicly funded enrollees, accounting for 32.2 percent of the plans. However, there are substantial numbers of other plans, with about one-fourth being nonprofit plans that have both public and commercial enrollees, and the remainder being for-profit, evenly distributed between public-only and public and commercial.

Figure 6: Types of Managed Care Organizations Participating in Medicaid in Study States, 2010

The plan-type pattern is different across states. Most states, except the smallest, have a mix of at least three plan types. However, two states (Massachusetts and Minnesota10) were contracted only with nonprofit plans in 2010, and Tennessee was contracted only with for-profits. All states but Delaware contract with at least one or more plans with some commercial enrollment.

There is a substantial presence of large, national managed care companies in the study states. As evidence, we generally interviewed (as one of two MCOs interviewed) the largest health plan in the state in terms of Medicaid managed care enrollment. Of the 40 plans representatives interviewed, 16 (40 percent) are from one of the following MCOs: Aetna, Amerigroup, Anthem/WellPoint, Centene, Molina Healthcare, or United Healthcare. Some of these large national MCOs are public-only, and some have commercial enrollment.

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