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75% of Medicaid Recipients Will Be Covered by an MCO by 2015

An increasing number of Medicaid recipients are receiving their benefits through a managed care organization. Most of the new Medicaid enrollees under the Affordable Care Act will also be covered by an MCO.

A managed care organization was already providing Medicaid coverage to 63% of recipients in 2012. With all the new enrollees, that number is expected to rise to 75% inQuality Patient Care 2015.

Medicaid is the primary payer for long-term care services in the United States, and costs vary significantly from patient to patient. Coverage provided by a managed care organization means costs don’t fluctuate and budgeting is more feasible.

“By providing capitated payments to these plans, states can have more budget certainty than if they were paying out Medicaid claims on a fee-for-service basis,” explained Tim Mullaney of McNights in a recent article.

Fee-for-service Medicaid will end in many states as the managed care organization model takes its place.

There is also hope that benefits provided through a managed care organization will improve patient care.

“The idea is that this incentivizes cost control while allowing beneficiaries to receive needed care in the most appropriate setting, without being hampered by the often tangled rules and requirements,” wrote McKnight.

Some believe benefits provided through an MCO will improve healthcare services to underserved rural communities and provide some services that otherwise would not be provided by state Medicaid coverage.

Not everybody thinks benefits provided by a managed care organization solves the whole problem. Many long-term care providers say it doesn’t do enough to close the gap between the real costs of providing long-term care and Medicaid reimbursements rates.

General Medicine, The Post Hospitalist Company can help you improve services and control costs at your long-term care facility. Our overarching goal is to enhance and coordinate care of older adults and chronically ill patients in all post-acute settings.

Tom Prose
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