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Use of Funds by Medicaid Managed Care Organizations

Managed care is a health care delivery system organized to manage cost, utilization, and quality. In 2015, Federal Medicaid managed care payments were approximately $161.8 billion, which was more than 40 percent of the $349.8 billion in total Federal expenditures for Medicaid. States continue to expand their use of managed care. To deliver services to Medicaid managed care enrollees, States contract with managed care organizations (MCOs) and make monthly payments, called a capitation payment, to those plans to provide enrollees with Medicaid-covered services. Appropriately set capitation rates help to ensure that adequate payments are made to provide services to beneficiaries. We will examine how Medicaid funds received by MCOs are used to provide services to enrollees.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
November 2017 Centers for Medicare & Medicaid Services Use of Funds by Medicaid Managed Care Organizations Office of Audit Services W-00-18-31526 2019

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