The Smart Shopper’s Guide to Medicaid Managed Care Plans
These days, when we shop for even the smallest items, we have online reviews to help us find the best deals. But when it comes to the big-ticket item called Medicaid managed care, it’s been a lot harder. Consumer advocates and other stakeholders have struggled to locate information on the performance of the multistate companies that are increasingly winning state contracts to manage Medicaid programs. Without this information, it’s impossible to get a complete picture of how well a managed care company is likely to serve consumers.
In this season of giving, Community Catalyst has teamed up with the Kaiser Family Foundation to create an online tool that gathers in one place, for the first time, key data on the records of these companies. The Medicaid Managed Care Market Tracker includes quality scores and state-imposed sanctions. The tracker also enables comparisons across states’ Medicaid managed care programs, including network access standards and the percent of premiums that go to care versus profits. All of this can help ensure consumers – both individuals and states – are getting their money’s worth.
More than half of Medicaid beneficiaries are already in risk-based managed care plans, and states are rapidly expanding managed care to seniors and people with disabilities. In many states, this is tied to closing the coverage gap or demonstration projects for people eligible for both Medicaid and Medicare. Medicaid managed care can improve coordination, quality and efficiency of services. But it can also be risky for consumers, if the companies put profits ahead of people.
The Medicaid Managed Care Market Tracker lets you peer inside the wrapping of these companies.
For example, you can learn that from 2010 through 2013, for-profit UnitedHealth Group plans were sanctioned in seven states for offenses ranging from improperly denying speech therapy services in Florida (fined $1,305,000) to failing to meet standards for children’s preventive services and vaccinations in Arizona (fined $200,000). Or that Molina’s Texas plan paid the largest state fine during that period: nearly $3 million for problems including blocking access to needed medications, a skimpy provider network and poor handling of consumer complaints.
You can also learn that UnitedHealth’s Rhode Island plan, which did not face any sanctions, received one of the highest overall quality scores – 85.5 out of 100 – from the National Committee for Quality Assurance. The plans scoring higher were all non-profits.
Other data show some states are paying a high price for having the companies manage their Medicaid programs. For example, in Delaware and Nevada, the companies took nearly 25 percent of taxpayer-supported premiums off the top, spending only 75 percent of premiums on care for state residents. These numbers cry out for closer examination of whether consumers are getting the quality and quantity of care they need.
Here are some more ways to use the new tool:
- Check out plans operating in your state or planning to bid on business in your state
- Identify how your state’s managed care standards stack up to those in other states and advocate for stronger standards
- Identify the parent companies of plans in your state and their performance, so you can learn more about their corporate standards
- Educate policymakers as they consider expanding Medicaid managed care and/or contracting with new plans
- Highlight promising and problematic plans for media
- Advocate for more public accountability for the public dollars spent on managed care
To learn more about the tool, please join a webinar hosted by Kaiser Family Foundation on Thursday, December 11 at 12:30 PM EST.
Now if we could only turn this into an app….