What is Managed Care?
Managed Care is a healthcare delivery system organized to manage cost, utilization and quality. Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCOs) that accept a set per member per month (capitation) payment for these services.
By contracting with various types of MCOs to deliver Medicaid program health care services to their beneficiaries, states can reduce Medicaid program costs and better manage the utilization of health services. Improvement in health plan performance, health care quality and outcomes are key objectives of Medicaid-managed care.
Some states are implementing a range of initiatives and integrate care beyond traditional managed care. These initiatives are focused on improving care for populations with chronic and complex conditions, aligning payment incentives and performance goals and building accountability for high-quality care.
- Managed Care Programs
A Managed Care Organization (MCO) is a health care company, often called a "health plan." It is a group of doctors, hospitals and other providers who work together to meet member healthcare needs.
Healthy Connections Prime
Healthy Connections Prime is an enhanced program that combines all of the benefits of Medicare and Healthy Connections Medicaid under a single Medicare-Medicaid Plan to make it easier for members to get needed health services.
Program For All-Inclusive Care Of The Elderly (PACE)
PACE is a program under Medicare, and states can elect to provide PACE services to Medicaid beneficiaries as an optional Medicaid benefit. To find out if you’re eligible and if there’s a PACE program near you, search for PACE plans in your area, or call your Medicaid office.
Dual Special Needs Plans (SNP)
A Special Needs Plan (SNP) is type of Medicare Advantage Plan (MA) that provides benefits to members who have Medicare and Medicaid. First offered in 2006 as result of the 2003 Medicare Modernization Act to individuals identified by CMS.