In many ways, Medicaid has been the standout health-related support for children and families during the COVID-19 pandemic. The program is well supported in the Build Back Better Act and will continue to grant people access to healthier lives long after the current public health emergency (PHE) ends (the PHE was recently extended for another 90 days, effective from January 16). A fact that has become clearer than ever during this PHE is that managed care organizations (MCOs) are the touchpoint for most, if not all, beneficiaries. Medicaid enrollees interact almost exclusively with their MCO to understand how to utilize coverage options, so it is critical that these organizations optimize available information. As we begin this new year and anticipate the (eventual) end of PHE Medicaid protections, beneficiaries will rely even more on their state’s Medicaid website for MCO information.
The original objective of this blog was to research and highlight best practices for state Medicaid authorities to prioritize equity by sharing MCOs’ Race, Ethnicity, and Language (REL) data. We searched nine states’ Medicaid websites for data regarding pre- and postnatal care, behavioral/mental health treatment, substance use disorder (SUD) treatment, and dental care. We quickly identified a lack of robust, easy to understand data on fundamental topics, including current MCO enrollment numbers, beneficiary demographics, and the uptake of basic services. We were often unable to locate any data, let alone disaggregated data.
Our analysis, like the research conducted by our colleagues at the Georgetown Center for Children and Families, identified a lack of data regarding the enrollment of children and pregnant persons, Early and Periodic Screening, Diagnostic and Treatment (EPSDT) utilization, and race/ethnicity. Currently, every Medicaid website is unique, and many lack information, are difficult to navigate, and/or are cluttered with dead links – in two cases, the state Medicaid websites (that shall remain nameless) were completely down without indication of when they might be back online.
The following recommendations, based on our research, information from other experts, and conversations with advocates, would make MCO data on any Medicaid website more accessible and user-friendly.
Recommendation 1: Create a uniform system to analyze MCOs
States use a variety of methods to assess their Medicaid MCOs and compare performance. When assessing the MCOs currently operating in their states, Florida uses stars and Kansas uses gauges. Presently, states use diverse comparison metrics to assess MCOs: specific performance over a period of time, breakdowns of multiple MCOs, or comparisons to external standards like Healthcare Effectiveness Data and Information Set (HEDIS) measures. Many states fail to explain if or how they evaluate or rate MCOs.
State Medicaid agencies should utilize a standardized, easy to understand MCO rating system. Using HEDIS measures to quantify successes and shortcomings would make it possible to easily compare the Aetna MCO in New Jersey to the Aetna MCO in Texas. It would also create a simplified system allowing individuals, navigators, and advocates to compare plans within a state. The standardization of data across all states would be ideal; however, this is a long-term goal that would require federal synchronization. In the interim, state agencies can transparently share data they already collect. This would serve two purposes. MCO data informs enrollees and stakeholders about coverage options and highlights discrepancies across companies, thereby informing optimal MCO selections. Additionally, sharing data in a transparent way encourages other states to do so, which promotes equity.
Recommendation 2: Create an easy-to-locate dashboard that compares MCOs within a state
Many states house multi-year analyses of MCOs on their websites – unfortunately, these are often posted as PDF documents consisting of dozens of pages, that can only be found through determined searching (rarely on a Medicaid website’s main landing page). It often appeared that this data were made intentionally hard to find.
While multi-year analyses were common, we were unable to locate information about the frequency by which they were conducted on any of the nine state Medicaid websites researched. When these documents are inaccessible, advocates and individuals are left to wonder the reasoning: are MCOs not sharing data with state Medicaid authorities, is Medicaid not publishing it, or is the searcher simply struggling to locate it?
Dashboards are ideal tools for presenting information at-a-glance. We scanned nine state websites and found zero MCO-specific dashboards. A dashboard that highlights standardized data from all of a state’s MCOs and across multiple years on the Medicaid website’s main landing page would allow interested parties to quickly compare providers. It would also create an added layer of accountability for MCOs as they seek to keep up with each other.
Recommendation 3: Routinely maintain and update Medicaid websites
Perhaps the most concerning finding of our analysis was discovering Medicaid websites that were not operational. Others were functional, but cluttered with an abundance of outdated information. When a Medicaid website is down for maintenance or unexpected reasons, the agency should strive to inform the public of the outage through other means (social media platforms like Twitter or Facebook, or the state’s Department of Health and Human Services website, for example). We imagine most people give up after a couple attempts to access a down website – we did, and searching Medicaid websites is our job. Medicaid programs should indicate how long they anticipate outages may last and alternate ways to obtain needed information. Medicaid sites should be routinely checked and updated, particularly to ensure MCO-related information is current and easy to find.
Recommendation 4: Capture and disseminate MCO data on health equity
When we asked advocates what they (and the enrollees they serve) want from state Medicaid websites, the answer was overwhelmingly dashboards and data. Nick Wood, an advocate in Kansas, stated “An interactive map would be the most useful tool, where people could see the availability of services in their county or zip code. Georgetown gave a presentation on Medicaid websites and talked about states posting outcome measures by different populations; we wish we had that as well.”
The COVID-19 PHE has been an opportunity for beneficiaries to experience Medicaid with several protections long championed by Community Catalyst and advocates to promote health equity. However, these protections will end with the PHE and it would be practical for MCOs to disseminate data to inform state outreach strategies. The Centers for Medicare & Medicaid Services has compiled some excellent resources encouraging MCOs to maximize continuity of coverage as states unwind PHE Medicaid protections.
MCOs house important data that, if disseminated resourcefully, could not only help beneficiaries understand their options, but also provide the state with needed information on how to improve various aspects of care. We believe these recommendations could help create transparency between people and their Medicaid coverage. If you’d like to advocate for MCO accountability in your state, we recommend reading this helpful MCO Advocate Guide from the Georgetown Center for Children and Families for more information. We’ve also created this letter template to advocate your state Medicaid authority.