Medicaid Health Plans

CIE Medicare Course

Medicaid health plans are playing a growing role in the Medicaid program. More than 27 million low-income individuals throughout the country-- representing nearly 50 percent of total Medicaid enrollment-- rely on Medicaid health plans. Medicaid health plans are at the forefront of implementing systems and programs that not only provide better care coordination for beneficiaries, but also help states control escalating program costs and achieve a high value for their health care dollars 

Medicaid health plans are helping states to modernize their delivery systems for vulnerable populations. For example, prior to enrolling in Medicaid health plans, many beneficiaries lacked primary care providers and, instead, relied on costly emergency rooms as their access point for services. Health plans are providing beneficiaries with continuity – and lower costs – through a dedicated provider that can coordinate care. In addition, beneficiaries often have needs that go beyond medical care that include behavioral and social welfare challenges. Medicaid health plans help facilitate patients’ contact with local, community-based services that can address broader needs. Medicaid health plans are also working with expectant mothers to provide prenatal care and counseling to help them transition to caring for newborns – programs that may far exceed anything available under Medicaid fee-for-service.

Medicaid health plans achieve cost savings for states while outperforming the fee-for-service program on key quality measures. According to a Lewin Group analysis of 24 state Medicaid Managed Care studies, Medicaid health plans provide savings of up to 20 percent compared to the fee-for-service programs. The analysis also showed that a comparison of drug costs under FFS programs vs. Medicaid health plans in multiple states found that the costs per-member per-month were 10 to 15 percent lower for health plans than for fee-for-service programs.

By bringing a coordinated and holistic care approach to Medicaid, health plans are improving the health and well-being of millions of low-income individuals and families and helping states to maximize scarce resources.

Latest Resources

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

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


Fact Sheets/Issue Briefs/Talking Points | Strategic Communications | 07/13/2012

AHIP Medicaid Chartpack - [PDF]


Charts | Product Policy | 07/10/2012

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

USA Today: States turn to private insurance companies for managed care

Kaiser Health News/USA Today examine how states are turning to Medicaid managed care plans to provide care for long-term care patients.

News Articles | 02/21/2011

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

AHIP Report: Medicaid Managed Care Cost Savings - A Synthesis of Fourteen Studies - [PDF]

According to the Lewin Group's review of 14 studies, Medicaid managed care has saved states up to 19% compared with fee-for-service Medicaid.

Reports/Research/White Papers | Center for Policy and Research | 06/01/2004