Amount of Medicaid Funds Flowing to MCOs Is Poised to Rise, KFF Predicts

Taking a look at the overall state of Medicaid managed care, KFF earlier this month compiled data from prior years of its surveys and analyses to identify notable trends. About 75% of all Medicaid beneficiaries are enrolled in risk-based managed care — with that percentage set to grow as Oklahoma transitions away from fee-for-service (FFS) Medicaid — and most states spend at least 40% of total Medicaid dollars on payments to MCOs. KFF noted that spending could increase as states shift higher-cost, higher-need beneficiaries, such as disabled individuals and adults aged 65 and older, into managed care. Moreover, most states (32 states including Washington, D.C.) with managed care carve in their pharmacy benefits to MCO contracts, observed KFF.

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