Medicaid Health Plans

CIE Medicare Course

States are increasingly relying on Medicaid health plans to promote high-quality, coordinated care for their growing Medicaid populations. More than 43.5 million low-income individuals – representing nearly 66 percent of total Medicaid enrollment – rely on private health plans for their Medicaid coverage.

These plans provide a variety of services to meet the unique needs of their beneficiaries, including programs to coordinate care for people with multiple chronic conditions; outreach and education initiatives to promote prevention and healthy living; and efforts to facilitate beneficiaries' access to non-medical support, such as social services or transportation.

Medicaid health plans achieve cost savings for states while outperforming the fee-for-service program on key quality measures. Recent research has shown that by coordinating medical and pharmacy benefits, Medicaid health plans saved $2.06 billion in state and federal expenditures in 2014 alone. Moreover, beneficiaries enrolled in Medicaid health plans are more likely to receive preventive services, as well as have fewer hospital admissions, and better access to primary care than the FFS program.

Latest Resources

Medicaid Managed Care Infographic - [PDF]

Medicaid health plans are at the forefront of implementing systems and programs that provide high-quality, comprehensive care to millions of low-income beneficiaries across the country.

Infographics | Strategic Communications | 07/30/2015

Medicaid Managed Care: Improving Patient Care and Achieving Cost Savings for States - [PDF]


Fact Sheets/Issue Briefs/Talking Points | Strategic Communications | 05/28/2015

AHIP Statement on Proposed Medicaid Managed Care Rules

Press Releases | Strategic Communications | 05/26/2015

Medicaid Managed Care: What You Need to Know - [PDF]

Fact Sheets/Issue Briefs/Talking Points | Strategic Communications | 05/26/2015

Comparison of Medicaid Pharmacy Costs and Usage in Carve-In Versus Carve-Out States

This paper examines 35 states and the District of Columbia that made use of the MCO capitation contracting model in their Medicaid program, transferring risk for medical costs to coordinate care for at least some of their Medicaid beneficiaries.

Fact Sheets/Issue Briefs/Talking Points | 04/01/2015

New Report: Allowing Medicaid Plans to Manage Pharmacy Benefits Leads to Cost-Savings for States

States in which Medicaid plans manage prescription drug benefits are realizing large-scale savings, according to a new analysis by The Menges Group.

Press Releases | Strategic Communications | 04/01/2015

Health Literacy and America’s Health Insurance Plans: Laying the Foundation and Beyond - [PDF]

This publication explains the innovative approaches that 30 health plans have taken to providing easily understood, actionable health and benefits information for consumers.

Reports/Research/White Papers | Center for Policy and Research, Strategic Communications | 11/15/2013

Medicaid Managed Care Plans Providing Higher Quality Care, Better Value for Taxpayers

As state Medicaid programs struggle to deal with rising medical costs and expanding populations, the targeted programs and services offered by Medicaid managed care plans are enhancing patients’ quality of life, improving health outcomes, and providing better value for taxpayers, according to a new report from America’s Health Insurance Plans (AHIP)

Press Releases | Strategic Communications | 03/05/2013

Innovations in Medicaid Managed Care: Highlights of Health Plans’ Programs to Improve the Health and Well-Being of Medicaid Beneficiaries

In this report—an update to AHIP’s 2005 Innovations in Medicaid Managed Care book—we provide details about 17 health plan initiatives dedicated to improving the health and well-being of Medicaid beneficiaries.

Research | Center for Policy and Research | 03/04/2013

Capitol Hill Briefing on Access and Quality in Medicaid Managed Care

AHIP hosted a Capitol Hill briefing on how Medicaid health plans improve access and quality of care for beneficiaries while providing cost savings to states. The briefing featured presentations from four Medicaid health plan executives.

AHIP Coverage Blog Posts | 05/11/2011

Medicaid Health Plan Enrollment and Participation Trends, May 2011

This report by America’s Health Insurance Plans (AHIP) analyzes enrollment and participation trends in Medicaid managed care plans. Of the 50.5 million Medicaid beneficiaries nationwide, 23.9 million were enrolled in a Medicaid health plan as of June 30, 2009, an increase of 2.4 million since 2008.

Reports/Research/White Papers | Federal | 05/09/2011

Medicaid Health Plans: Adding Value for Beneficiaries and States - [PDF]

This synthesis of research by America’s Health Insurance Plans (AHIP) demonstrates that Medicaid health plans provide high quality accessible care to beneficiaries and value to states.

Reports/Research/White Papers | 05/20/2009

Innovations in Medicaid Managed Care

Health insurance plans are implementing a multitude of creative programs to improve quality and efficiency in Medicaid.

Reports/Research/White Papers | Center for Policy and Research | 03/01/2005