Commonwealth Fund Reviews State Options for Addressing Medicaid MCO Performance Issues
The Commonwealth Fund published guidance on how state Medicaid agencies can address underperforming managed care plans through contractual tools and staff oversight strategies. The analysis covers corrective action plans, financial penalties, contract suspension, and systematic performance monitoring approaches states can deploy when plans fail to meet quality, access, or administrative standards. The guidance emphasizes strategic prioritization of enforcement resources and graduated remedies. State Medicaid agencies managing MCO contracts gain a framework for structuring performance oversight and escalating interventions when plans fall short of contractual obligations.
States with delegated managed care functions must actively enforce MCO performance standards or risk network adequacy failures, quality lapses, and CMS compliance violations — this outlines graduated enforcement mechanisms available under managed care contracts.
Managed Care
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