How are health insurance providers serving Medicaid beneficiaries?

States are increasingly relying on Medicaid health plans to promote high-quality, coordinated care for their growing Medicaid populations. More than 56 million low-income individuals—representing about 78% 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 fee-for-service program.

Over 80 million Americans are covered by Medicaid and the Children’s Health Insurance Program (CHIP)

– Over 65 million people are in Medicaid
– More than 6.6 million kids and pregnant women are in CHIP

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More than 56 million receive their Medicaid benefits from private health plans

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