Measuring Up: A Novel Approach to Assessing State Oversight of Medicaid Managed Care
Issue Brief
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Key Findings
Key Findings:
- We identified 11 practices that met state norms, 3 that did not, and 3 that exceeded state norms. We also identified 9 practices that were unique to Washington or were not documented in the 2012 study.
- From the subjective assessment, we identified 5 practices that were mostly described as positive, 5 that received mixed assessments, and 3 that were mostly described as negative.
- Based on these quantitative indicators, as well as measures of quality and plan switching, we made several recommendations to the Washington State Medicaid agency about improving its oversight.
States can deliver Medicaid services to people through a number of models, one of which involves contracts with managed care organizations (MCOs) to provide Medicaid benefits to enrollees in exchange for a monthly payment from the state. In 2012, 36 states and the District of Columbia contracted with MCOs, which covered nearly 75 percent of the 57 million Medicaid beneficiaries nationwide. States that contract with managed care plans must demonstrate to a variety of stakeholders, including the Centers for Medicare & Medicaid Services, that the state Medicaid agency is appropriately overseeing the plans. This includes monitoring enrollees’ access to care as well as the quality and cost of services. However, there are no recognized standards for what constitutes sufficient monitoring, which has hindered efforts to assess the effectiveness of state oversight. This brief describes a novel approach that Mathematica Policy Research used to evaluate state oversight of a new Medicaid managed care program for people with disabilities in Washington State.
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