All stories
Jump to date
Thursday, May 28 · 3 stories
- Managed Care
Medicaid MCOs Deploy Community Health Workers to Close Pediatric Care Gaps
Community health workers (CHWs) are emerging as a strategic tool for Medicaid managed care organizations to address missed well-child visits, immunization delays, and undiagnosed chronic conditions in pediatric populations. CHWs connect families to care by addressing social determinants and system navigation barriers that fragment service delivery. For MCOs, CHW programs offer a mechanism to improve HEDIS measures, close pediatric quality gaps, and meet contractual performance targets while addressing upstream factors that drive preventable utilization. State Medicaid agencies are increasingly encouraging or requiring MCO investment in CHW models as part of value-based care strategies.
- Managed Care
TV Drama Highlights Medicaid Redetermination Barriers Affecting Coverage Continuity
The Max series 'The Pitt' depicts a common Medicaid coverage loss scenario: a redetermination notice sent to an outdated address, followed by prolonged re-enrollment struggles due to documentation requirements. The storyline reflects real-world challenges MCOs face during the unwinding period, where administrative barriers—including unforwarded mail and burdensome income verification for gig workers—disrupt continuity of care. Health plans should note this mirrors ongoing member retention issues and the need for robust outreach systems to prevent procedural terminations.
Wednesday, May 27 · 2 stories
- Managed Care
MACPAC Urges Managed Care Transparency Reforms, HCBS Access Improvements in March Report
The Medicaid and CHIP Payment and Access Commission released its March 2025 report recommending improvements to external quality review processes in Medicaid managed care, enhanced access to home- and community-based services, and reduced administrative burdens for states and CMS. The recommendations target managed care transparency and accountability mechanisms that directly affect MCO operations and oversight. MACPAC reports to Congress typically influence future CMS rulemaking and state policy decisions. Managed care organizations should review the full report for potential operational and compliance implications.
- Managed Care
NASHP Hosts State-Only Webinar on PBM Oversight Approaches
The National Academy for State Health Policy will host a state-only webinar on May 20 covering state approaches to pharmacy benefit manager oversight and federal policy developments. The session targets state officials working on PBM regulation and oversight strategies. The webinar will likely address emerging state legislative and regulatory approaches to PBM transparency, contracting practices, and oversight mechanisms. This matters for Medicaid managed care organizations as states increasingly scrutinize PBM practices that affect prescription drug costs and access in Medicaid programs.