Medicaid Covers Us: Conveying the Value of Medicaid

Andrea Bennett, PhD, MSW, Katrina Miller Parrish, MD, FAAFP, Citseko Staples Miller, Carter Steger, MPA, Nicole Truhe, MPA, Caroline Adams

Medicaid Covers Us is a public education project that highlights the role of the Medicaid program in the lives of individuals, families, and communities, their interactions with the nation’s health care systems, and how it impacts state/local economies. The project focuses on sharing stories from the perspective of individuals and families, clinicians, payers, business and community leaders, and others in the Medicaid ecosystem to articulate the value of the program. The project aims to dispel myths and common misperceptions about Medicaid. Led by the American Cancer Society Cancer Action Network (ACS CAN), the project describes how Medicaid can provide cancer patients and survivors access to life-changing and lifesaving treatment and care. In response to the COVID-19 pandemic, Medicaid Covers Us has highlighted the protective nature of Medicaid during the pandemic and the role of Medicaid in addressing and reducing health inequities.

During the pandemic, the Medicaid program has served as a particularly important safety-net during the pandemic, providing access to care for both previously and newly eligible individuals throughout the global health crisis. Continued coverage of a comprehensive suite of services is critical for protecting the health and wellbeing of enrollees during this time. However, with increasing state budget pressures due to the pandemic, some states have indicated a desire to cut or carve-out some benefits.

An important player in the Medicaid ecosystem is the managed care organization (MCO). As of 2018, over 75 percent of all Medicaid enrollees were enrolled in a Medicaid managed care plan. Furthermore, as of July 2019, almost all states (40) used some form of managed care in their Medicaid program. Medicaid MCOs support states in reducing costs and better managing the utilization of services for enrollees by ensuring that members receive the right care at the right time. States are increasingly relying on MCOs to manage the care of Medicaid enrollees partly because contracting with MCOs allow for greater budget predictability. As MCOs are at financial risk for the enrollees they serve, they also have an incentive to provide high-value services, including benefits in addition to those that are required under a Medicaid state plan. MCOs coordinate the care of enrollees to reduce costs and better address physical and behavioral health needs. In addition, MCOs have the flexibility to coordinate with community-based organizations and other services and supports to address the social needs of enrollees.

Medicaid MCOs have taken important steps during the pandemic to ensure continued access to quality care, including allowing enrollees to receive 90-day refills of medication, enhancing telemedicine services, and connecting members to vaccines. To highlight best practices and innovative initiatives led by Medicaid health plans in 2020, IMI released a compendium highlighting initiatives in eight categories: high-risk care coordination, value-based payment, pharmacy, behavioral health, women’s health, child and adolescent health, managed long-term services and supports, and social determinants of health. Many of the featured health plans had to adapt pre-existing plans to respond to member needs during the pandemic. To read more about how innovation in Medicaid at the health plan level, access IMI’s recently released report here.