CMS’s 2020 Final Medicaid Managed Care Rule: A Summary of Major Changes

KFF November 23, 2020
Elizabeth Hinton, MaryBeth Musumeci

Managed care is the predominant Medicaid delivery system in most states, with over two-thirds of beneficiaries enrolled in comprehensive risk-based managed care organizations as of July 2019, and millions of others covered by limited-benefit risk-based plans or primary care case management programs. On November 13, 2020, the Centers for Medicare and Medicaid Services (CMS) finalized revisions to the Medicaid managed care regulations which were proposed in November 2018. CMS previously finalized a major revision to these regulations in 2016, under the Obama Administration. A few months after taking office, the HHS Secretary and CMS Administrator under the Trump Administration released a letter to state governors noting their plan to conduct a “full review of [Medicaid] managed care regulations to prioritize...

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