Medicaid Managed Care

Costs, Access, and Quality of Care

Medical professionals take blood pressure of members of the public at a health fair.

The Affordable Care Act encourages states to implement a major expansion in Medicaid eligibility. Many of the new beneficiaries will be enrolled in Medicaid managed care. At the same time, states increasingly are looking to managed care to cover more high-cost populations and services. In addition to potential savings, states value the budget predictability that comes from managed care. Consumer advocates and providers, however, have expressed concerns about network adequacy, access to care and quality of care, especially as states move more high-cost populations to managed care.

This synthesis examines the evidence on whether states have saved money using managed care for their Medicaid populations and whether managed care beneficiaries have better access to services or receive higher quality care than their fee-for-service counterparts.

Key Findings:

  • There is little evidence of national savings from Medicaid managed care, but a few states have had some success. The states that did realize cost savings were more likely to be states with relatively high reimbursement rates under fee-for-service.
  • Medicaid managed care has had mixed success in improving access to care. There is some evidence of increased likelihood of a usual source of care and reduced emergency department visits, but pregnant women were generally no better off under managed care then in fee-for-service.
  • Quality of care in Medicaid managed care has not been well studied, making it difficult to compare quality in fee-for-service to managed care. This is surprising given that states require performance measures for all managed care plans.