Types of managed care arrangements

Thirty-three states and the District of Columbia have limited-benefit plan arrangements. As of 2016, 15 states contracted with behavioral health limited-benefit plans, 15 states contracted with non-emergency transportation vendors, 10 states contracted with dental plans, and 4 states contracted with MLTSS limited-benefit plans (MACPAC 2018).

According to CMS, about 11.2 million Medicaid enrollees (about 14 percent) are enrolled in behavioral health plans (PIHPs and PAHPs). About 305,000 enrollees receive managed LTSS only, which is about 0.4 percent of the total Medicaid population. Enrollment in dental plans is approximately 6.7 million enrollees, about 9.7 percent of the total Medicaid population. Around 13.4 million enrollees or 17 percent of the total are in a transportation limited-benefit plan. Limited-benefit plans labeled as “other” account for 1.8 percent of the total Medicaid population (MACPAC 2018).

TABLE 1. Overview of Medicaid FFS and Medicaid Managed Care Arrangements

Key system features

Limited-benefit plans

Notes: FFS is fee for service. HEDIS is Healthcare Effectiveness Data and Information Set. NCQA is National Committee for Quality Assurance. PCCM is primary care case management. PCP is primary care provider. URAC, originally known as the Utilization Review Accreditation Commission, has been referred to solely by its acronym since 1996.Some states have contracted with vendors to administer elements of their programs. Known as administrative services organizations (ASOs), these vendors are typically paid a non-risk-based fee to provide administrative services. While not defined within federal statute or regulations, depending on how they are structured, ASOs may or may not be classified as a managed care arrangement. Limited-benefit plans may have all, some, or none of the elements of the key system features listed above, depending on the benefits covered and type of contracting arrangement with a state. For example, state contracts with limited-benefit plans for providing behavioral health or oral health services may include requirements regarding network development, assistance to enrollees seeking services and development of member materials. PAHPs are not required to conduct an external quality review.

Source: MACPAC analysis

Learn more about the characteristics of managed care plans, including managed care firms’ Medicaid managed care enrollment market share.