Twenty-First Century Medicaid: The Final Managed Care Rule

With enrollment reaching 74 percent of all beneficiaries, it is clear that managed care has become the standard organizing mechanism for a Medicaid program whose welfare roots are behind it and that now functions as a principal source of public insurance. Given this broad national policy direction, a strong yet flexible regulatory framework for Medicaid managed care becomes a fundamental policy goal, particularly as state programs continue to evolve toward structures capable of managing care for the highest need populations.

The modern contours of a 21st century regulatory framework finally came into full view on April 25 with the release of a 1,425-page final rule that will guide the delivery of health care for tens of millions of children and adults. All insurance regulation is important given the population health and welfare considerations at stake in modern health care financing structures. But nothing quite rivals Medicaid managed care in terms of the complexity involved in delivering and paying for health care for the poorest populations, who face particularly high health risks. As such, the importance of the Medicaid managed care rule for coverage, access, quality, efficiency, and value hardly can be overstated.

– Health Affairs

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