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GAO-12-872R 1 (2012-08-17)

handle is hein.gao/gaobacgkn0001 and id is 1 raw text is: Accountabiliy - Integrity - Reliability United States Government Accountability Office Washington, DC 20548 August 17, 2012 The Honorable John D. Rockefeller, IV Chairman Subcommittee on Health Care Committee on Finance United States Senate The Honorable Henry A. Waxman Ranking Member Committee on Energy and Commerce House of Representatives Subject: Medicaid: States' Use of Managed Care The Medicaid program, a joint federal-state program that finances health insurance coverage for certain categories of low-income individuals, is an important source of health care coverage for about 67 million beneficiaries. As Medicaid enrollment and spending have increased significantly over the past decade, so too has states' use of managed care to provide services to Medicaid beneficiaries, and nearly all states enroll some Medicaid beneficiaries in a form of managed care. Within some general requirements set out by the Centers for Medicare & Medicaid Services (CMS), the federal agency responsible for overseeing the Medicaid program, states have broad flexibility to implement Medicaid managed care programs. As a result, states vary widely in terms of the scope of services they provide and the populations they enroll in managed care. For example, while states commonly contract with managed care organizations (MCO) to provide the full range of covered Medicaid services to certain enrollees,1 they also frequently rely on other arrangements, such as limited benefit plans,2 which provide a limited set of services, such as dental care or behavioral health services, or primary care case management (PCCM) programs, in which enrollees are assigned a primary care provider (PCP) who is responsible for providing primary care services and for coordinating other needed health care 1States pay MCOs a set, or capitated, per member per month fee to provide enrollees access to contracted services and coordination of care. 2Some states enroll Medicaid beneficiaries into limited benefit plans, which generally are paid on a prepaid basis for providing a limited set of covered services, such as dental care, behavioral health care, and transportation, to beneficiaries. GAO-12-872R Medicaid Managed Care

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