Comprehensive, capitated managed care is the dominant Medicaid delivery system, accounting for about 78% of beneficiaries (over 66 million individuals as of July 2024) and 50% of total Medicaid spending (over $458 billion in FY 2024). States were contracting with over 280 individual Medicaid managed care organizations (MCOs) (as of July 2022), which represent a mix of private for-profit, private non-profit, and government plans. Medicaid Managed care contracts are among the largest and most complex state contracts, frequently exceeding billions of dollars a year. While the majority of states contract with managed care plans, states decide which populations and services to include in managed care arrangements, leading to considerable variation across states. States have been largely responsible for monitoring and overseeing managed care plans, while federal rules have evolved over time. Historically, publicly available managed care performance data has been limited and inconsistently available across states, limiting transparency and accountability of individual plans.
Sweeping changes to Medicaid managed care rules and regulations in 2016 and 2024 included provisions related to beneficiary protections, access, and program oversight, including new managed care reporting and oversight requirements and efforts to promote transparency. The first Trump administration relaxed some managed care requirements in rules issued in 2020, but the administration left the managed care reporting requirements intact. To date, the Centers for Medicare and Medicaid Services (CMS) has continued to publicly post newly collected state managed care reports on Medicaid.gov. It remains uncertain whether the Trump administration will seek to roll back or revise provisions included in the 2024 managed care final rules.
This brief describes the Managed Care Program Annual Report (“MCPAR”), a relatively new, comprehensive report on state managed care programs that includes plan-level data, that must be submitted (to CMS) by states annually. It functions alongside other managed care reports aimed at improving state and federal managed care program monitoring, oversight, and transparency. (Future KFF analysis will explore policy relevant metrics from the data.)
