Legal protections are crucial to ensure that Medicaid enrollees access necessary benefits and services from MCOs
As of 2016, more than 81 percent of people enrolled in Medicaid receive health care services through managed care. Risk-based managed care can help states predict Medicaid costs since it provides fixed payments for covered services. Medicaid enrollees may encounter problems accessing needed benefits and services because Managed Care Organizations (MCOs) may have a financial incentive to deny care. If enrollees use fewer services, the MCOs can keep any leftover payment as profit.
National Health Law Program has worked since the mid-1980s to ensure robust consumer protections in managed care, holding MCOs and state agencies accountable for their obligations to Medicaid enrollees.