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Medicaid Managed Care


Managed care as an industry has changed and evolved since its inception in the 1960s and 1970s.  It began as a means to contain costs through control of access to, and frequency of,  services. It has now become a premier model of the best way to deliver the correct services in the correct setting. The industry is now able to provide better care and wellness based services, using this model, by leveraging the knowledge base to negotiate more appropriate rates. It can also make use of the opportunity provided for quality management in the healthcare marketplace.

Managed Care in Medicaid

Medicaid managed care grew rapidly in the 1990s. In 1991, 2.7 million beneficiaries were enrolled in some form of managed care.  By 2004, that number had grown to 27 million, an increase of 900%.  Of the total Medicaid enrollment in the United States in 2004, approximately 60% are receiving Medicaid benefits through managed care.  All states except Alaska, New Hampshire and Wyoming have all, or a portion of, their Medicaid population enrolled in an MCO.  States can make managed care enrollment voluntary, or seek a waiver of section 1915(b) of the Social Security Act (the Act) from CMS to require certain populations to enroll in an MCO. 

EQR Managed Care Organization Protocol [ZIP, 821 KB]
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Page Last Modified: 10/09/2008 4:15:26 PM
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