Medicaid Managed Care

Medicaid managed care is increasingly being repositioned around state-led value-based models that tie payment to maternal outcomes, drug affordability, and cross-payer accountability: NASHP’s review of Medicaid maternity payment reform and Milbank’s Medicaid ACO work point to growing use of episode payments, quality incentives, and care coordination infrastructure to improve perinatal outcomes while managing cost and equity goals. At the federal level, CMS under the Trump administration is pushing Medicaid drug-price accountability through the GENEROUS Model, with projected savings of $64.3B, creating new pressure for MCOs, states, and provider-led VBC entities to integrate pharmacy strategy into total-cost-of-care performance. The strategic tension for ACOs and Medicaid managed care plans is that broader risk-based contracting—especially emerging Medicare-Medicaid alignment concepts like Medicaid risk contracts in ACO LEAD—could improve accountability for duals and high-need populations, but only if states can balance actuarial risk, data-sharing, and safety-net provider capacity while sustaining targeted investments in areas like Medicaid maternity VBP.