IMI Survey Highlights Continued Financial Pressures for Managed Care Organizations

The Institute for Medicaid Innovation (IMI) released the 2026 Annual Medicaid Managed Care Organization (MCO) Survey: Medicaid Health Plan Demographics Fact Sheet, offering a national snapshot of Medicaid managed care organizations representing more than 80% of states with capitated Medicaid managed care. The survey offers key insights into how Medicaid managed care organizations (MCOs) operate across the country.

The Medicaid MCO Demographics Fact Sheet, highlights continued financial pressures facing Medicaid health plans, including substantial declines in the percentage of Medicaid health plans reporting that capitation rates were adequate to cover expenses in 2025 compared to 2024. The survey also found that 67% of health plans received rate adjustments or additional state funding for 2025 rates, underscoring ongoing fiscal challenges across the Medicaid landscape. Additionally, more than half of surveyed Medicaid health plans reported prioritizing the employment of individuals with lived Medicaid experience or caregiving experience, reflecting growing emphasis on community-informed leadership and care delivery

The survey, now in its ninth year, represents the combined effort of IMI’s Survey National Advisory Committee and Medicaid thought leaders from across the field. This year, IMI has pivoted from one long survey to three brief surveys that are aligned with policy topics of particular interest to health plan and policy partners. The three surveys for 2026 include health plan demographics, behavioral and mental health, and pharmacy benefits. The new process will be more streamlined for respondents; allowing results to be released in a shorter timeframe and will be available to the field at key moments throughout the year. Each of the survey iterations contains questions carefully identified through workgroups and committees to elicit responses that will ultimately support the work of policymakers, researchers, and health plan representatives.  The findings provide critical insight into the structure, scale, and operational environment of Medicaid health plans across the country.