Medicaid

39 states and the District of Columbia choose to partner with private health plans to deliver Medicaid benefits for more than 57 million people across the country – over two-thirds of all Medicaid enrollees. These Medicaid managed care programs work with states to improve quality and access to care while controlling costs, saving billions of taxpayer dollars by streamlining services and working directly with care providers.

Medicaid health plans also work closely with local leaders and community organizations to improve health. Together, they help enrollees meet challenges like finding long-term housing, transportation for doctor’s appointments, access to nutritious foods, and even helping with necessities such as home heating or air conditioning units.

States hold Medicaid managed care plans accountable through requirements for access to providers, quality of care, caps on administrative costs, and limits on health plan profits. The facts show that Medicaid managed care plans provide states with budgetary and administrative savings. The vast majority of every Medicaid dollar pays for direct medical care, while Medicaid managed care plans’ profit margins average less than 2%. In addition, research shows that Medicaid enrollees have access to care that is similar to those who have coverage through their jobs, and are satisfied with their coverage.

The COVID-19 crisis has shone a spotlight on Medicaid as a critical source of high-quality health coverage for tens of millions of hard-working Americans, children, older adults, people with disabilities, and veterans. The economic impact of COVID-19 has led to increases in Medicaid enrollment across the country, with enrollment increasing by more than 6 million people, or 8.6% nationwide, between February and September 2020. Medicaid and Medicaid managed care programs have taken decisive actions to help patients and curb the spread of the virus. These actions include eliminating the cost of COVID-19 diagnostic testing and treatment, expanding access to telehealth and behavioral health services, establishing programs and partnerships in local communities to support the most vulnerable populations, and much more.

THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP)

Nearly 8 million children are covered by CHIP. Depending on the state, these programs may be part of Medicaid or separate.

CHIP often provides health care coverage to low-income children whose families make too much to qualify for Medicaid. CHIP programs also may cover pregnant women to ensure kids have the best possible start from birth.

MEDICAID EXPANSION

38 states and DC have expanded their Medicaid programs. That means they’ve increased the number of low-income Americans eligible for coverage. So far, these expansion programs have resulted in an additional 16 million Americans gaining coverage across the country. Also of note, close to 80% of expansion enrollees are covered by Medicaid managed care plans – a testament to the key role that private plans play in ensuring better outcomes and a better patient experience overall.