Health Affairs May 13, 2024
Sara Rosenbaum, Maria Casoni

On April 22, the HHS Centers for Medicare and Medicaid Services (CMS) published a long-awaited final rule regulating the use of managed care in Medicaid and CHIP. The official Federal Register version was published on May 10 (89 Fed. Reg. 40542); the nearly-900-page rule is a daunting read.

The managed care rule’s importance can hardly be overstated. As of 2022, three-quarters of states relied on managed care as a basic element of their Medicaid state plan administration. Over 80 percent of beneficiaries are enrolled in some form of managed care arrangement, and three quarters (66 million children and adults as of 2021) are members of plans offering a comprehensive range of inpatient and outpatient care, similar to private insurance.


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Topics: CMS, Govt Agencies, Insurance, Medicaid, Patient / Consumer, Payer, Provider, States
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