New Resource Shows How Different States Address Primary Care in Medicaid Managed Care Contracts

Most Medicaid beneficiaries have health insurance coverage through managed care organizations (MCOs), so the contracts that state Medicaid programs negotiate with MCOs shape the care their low-income populations receive. In recent years, states have increasingly used their managed care contracts to encourage improvement for specific groups or in specific areas, such as maternal health, and drive innovations in care and payment reform. To help researchers, state employees, and policy makers see how different states are addressing primary care in their contracts, a team of Department of Health Policy & Management researchers backed by the Commonwealth Fund built a public database of state Medicaid managed care contract provisions

The research team—Sara Rosenbaum, Maria Velasquez, Alexander Somodevilla, Elizabeth Gray, Rebecca Morris, Morgan Handley, and J. Zoë Beckerman—examined contracts from the 40 jurisdictions (39 states and the District of Columbia) that used comprehensive managed care for low-income beneficiaries as of the end of 2018. Their database allows users to search by state or by topic area: primary care payment methods, incentives, and disincentives; behavioral health integration; social determinants of health; performance and quality improvement; primary care access and network adequacy; primary care patient support; primary care coverage; and information sharing and use of technology.

An accompanying issue brief highlights key findings from the project. Some areas of similarity emerged—for instance, 39 jurisdictions measure performance in women’s health—along with several differences. Only 19 states specify that adult immunizations are a covered benefit, and seven states require MCOs to collect and report information related to social determinants of health such as housing, food insecurity, physical safety, and transportation. “We weren't surprised to see variation in contracts, because we know states have different on-the-ground healthcare conditions, different priorities, and different situations related to costs and procurement rules,” said Sara Rosenbaum.

Interviews with seven state Medicaid directors helped the team gain deeper insight into how states decide where to add specific requirements to contracts and where to allow MCOs discretion. The Medicaid directors also wanted to know how other states have used their contracts effectively to improve care for their residents with low incomes.  "This database is an important step toward building an evidence base that will help state Medicaid programs make the best contract choices for their circumstances,” said Elizabeth Gray.

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