Health Advocate: Medicaid Managed Care: Modernized Federal Regulations are Long

Health Advocate: Medicaid Managed Care: Modernized Federal Regulations are Long

Executive Summary

In 1965, when the Medicaid program was created, American health care bore little resemblance to the complex system we have today. One of the most significant changes has been the expanding role of managed care. In its early years, Medicaid was almost exclusively a fee-for-service system in which providers were reimbursed directly by state Medicaid agencies for each service provided. Now, nearly three quarters of Medicaid beneficiaries receive services through some type of managed care arrangement. Nearly all state Medicaid agencies now contract with managed care entities, which can reimburse providers, perform utilization review, respond to patient and provider complaints and set standards for coverage of services.

Related Content

For almost 50 years, the National Health Law Program has fought to expand access to quality health care to low-income individuals and underserved communities. Today we are pleased to launch a newly designed website for our future work to make health care a reality for all people. Please take time to peruse our new site, and sign up for our email updates to learn about us, watch the work we do, and become engaged.

Continue to site