IMI Releases 2025 Findings from Annual Medicaid MCO Survey

The Institute for Medicaid Innovation’s (IMI) 2025 Annual Medicaid MCO Survey offers key insights into how Medicaid managed care organizations (MCOs) operate across the country. Supported by the Robert Wood Johnson Foundation, the survey represents the combined effort of multiple volunteers and Medicaid thought leaders from across the field. Each distinct section of the survey contains questions carefully identified through workgroups and committees to elicit responses that will ultimately support the work of policymakers, researchers, and health plan representatives. 

In its eighth year, the 2025 survey captured perspectives from Medicaid health plans in nearly every state with capitated managed care, providing a national snapshot of plan structure, finances, services, and risk arrangements ahead of major policy changes taking effect in 2026. Despite several system challenges identified in these findings, plans expressed a strong appetite for policy solutions. Health plans overwhelmingly call for actions that strengthen the behavioral health workforce, standardize and expand data sharing, modernize pharmacy reimbursement frameworks, and invest in community-based behavioral health and substance use disorder services.  

The 2025 IMI survey findings provide policymakers, health plans, and other interested parties with a clear-eyed view of the Medicaid managed care environment—and a roadmap for policy and system reforms needed to support innovation, sustainability, and better outcomes for individuals, families, and communities enrolled in Medicaid. 

The IMI team is grateful for the Medicaid health plan representatives, serving on the Institute’s survey national advisory committee, who have devoted their time and effort to this important project.