Growing Pains for Medicaid Managed Care Expansions

Although they're not expanding Medicaid under the Affordable Care Act, Texas, Florida and other states are expanding managed care, bringing insurers opportunities as well as challenges, including competition from provider-based health plans.

Although they're not expanding Medicaid under the Affordable Care Act, Texas, Florida and other states are expanding managed care, bringing insurers opportunities as well as challenges, including competition from provider-based health plans.

In Texas, the unduplicated enrollment numbers in Medicaid managed care programs total approximately 2.84 million residents, and Superior HealthPlan, a subsidiary of Centene, and Amerigroup, a subsidiary of WellPoint, have received the bulk of managed care organization contracts over the past few years.

The Texas Health and Human Services Commission's managed care contracts include requirements that organizations have sufficient capacity to serve the expected enrollment, meet service area needs with geographic distribution of preventative, primary care, and specialty service providers, and report how often members go out of network.

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Source: Healthcare Payer News