Risk-based managed care is the current platform from which Medicaid recipients receive healthcare benefits, at least in part, in more than 30 states in the United States. Managed care organizations (MCOs) of all varieties contract with state Medicaid agencies to deliver and manage the healthcare benefits under the Medicaid program in exchange for predetermined capitation revenue.
Most states require that a contracted MCO also be a licensed health maintenance organization (HMO), which includes the requirement to file a statutory annual statement with the state insurance regulator.
This report, summarizing the 2010 financial results of organizations reporting Medicaid (Title XIX) experience, provides reference and benchmarking information for key metrics used in the day-to-day analysis of Medicaid MCO financial performance and explores the differences among various types of MCOs.