Medicaid Managed Care
Expert articles and analysis related to medicaid managed care.
AI Summary — Last 24 Hours
CMS is tightening Medicaid financing oversight through stricter Section 1115 budget-neutrality standards, raising the bar for states using waivers to fund delivery-system reform, behavioral health initiatives, and managed-care-linked population health programs—an immediate pressure point for Medicaid MCOs, providers, and state VBC strategies. At the same time, state-level managed care changes are accelerating: Ohio is standardizing behavioral health prior authorization across Medicaid plans, while Massachusetts is ending its Community Partner Program for 35,000 high-need beneficiaries, signaling a shift toward tighter administrative control and potential disruption for care management infrastructure. MCOs and risk-bearing providers should prepare for narrower waiver flexibility, intensified scrutiny of supplemental financing, and operational pressure to prove access and outcomes amid looming OBBBA Medicaid cuts and network adequacy concerns such as maternal health “ghost providers” ([CMS 1115 standards](https://news.google.com/rss/articles/CBMi-gFBVV95cUxQS1RuaV9tVFpGVFR2RS03SHF4WE93emxZSGstQ0RJbFJ6Rnl0U0ptZ3MwSVhSS0JNNmNzOFRyUmtvMEhPVFd5alFXb2hZY0oxMXZyeWJCUm4tVWdtaG1SN19xQWU2V19YeXI2enRMbG52TkVaLUlYZ3pPQWZCb
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