Medicaid is a government program that provides healthcare along with expanded benefits and services to millions of Americans.
The majority of states contract with managed care organizations (MCOs) to deliver Medicaid benefits. This approach, known as the managed care model, is a public-private partnership that aligns with federal and state requirements to deliver a higher standard of care.
Who Medicaid covers
70M
Medicaid provides coverage for over 70 million people, including 29 million children and 5 million people with disabilities.1, 2
Medicaid serves certain people experiencing low incomes, including pregnant women, children (including those in foster care), and seniors. Medicaid also serves people with disabilities.
States may choose to expand eligibility to additional groups. Individuals eligible for Medicaid must meet certain Federal Poverty Level (FPL) eligibility thresholds.
How Medicaid works
A federal and state partnership
States create and run a Medicaid program based on federal requirements to serve people in their state. States may also choose to provide more services or cover more of the population than is required.
The federal government has requirements that all states must follow when running Medicaid programs and provides at least 50% of the funding for these programs.
States may contract with MCOs to deliver coverage.
75%
The vast majority of states that contract with MCOs reported that 75% or more of their Medicaid beneficiaries were enrolled in MCOs1
The managed care difference
Why managed care
The managed care model is the only model with the structure and resources needed to address today’s complex healthcare needs, enabling states to deliver higher quality care and improve health outcomes.
With the cost of healthcare rising, managed care also allows states to better control cost trends and budget with predictability.
$7.1B
MCOs save federal and state tax payers $7.1B each year3
38
MCOs provide data to states on 38 federally-required quality measures, in addition to state-specific performance measures 4
39
39 out of 42 managed care states require MCOs to document and/or address barriers to positive health outcomes, such as lack of food, housing, and transportation5
Resources
The managed care difference goes beyond the basic check-up. To learn more about how managed care has gone above and beyond to address all aspects of health, click below.
Sources
- KFF, Medicaid Managed Care Tracker, as of 2022.
- MACPAC, MACStats: Medicaid and CHIP Data Book, Exhibits 14 and 30, December 2024. Note: Totals exclude M- and S-CHIP enrollment.
- The Menges Group, Potential Savings of Medicaid Capitated Care: National and State-by-State Estimates, July 2017.
- KFF and HMA, KFF Survey of Medicaid Officials in 50 states and DC , October 2024
- CMS, Child and Adult Health Care Quality Measures: 2024 Child and Adult Core Sets.