By Adam Sonfield
The year 2014 was the first year of the Affordable Care Act’s (ACA’s) broad expansion of Medicaid to individuals up to 138% of the federal poverty level. Despite the fact that 22 states have yet to agree to the expansion, Medicaid enrollment has surged. By December 2014, 70 million individuals—about one in five Americans—were enrolled in Medicaid or its sister program, the Children’s Health Insurance Program, an increase of 11 million from mid-2013.1
By the ACA’s design, almost all of these new Medicaid enrollees are receiving their coverage through health plans run not by the state but rather by private-sector managed care organizations (MCOs). And well before the ACA was implemented, most Medicaid enrollees—including most low-income women and men of reproductive age enrolled in the program—were in some form of managed care, making privately run MCOs integral partners in most states’ Medicaid programs.2
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