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Medicaid managed care organizations (MCOs) save money vs. FFS Medicaid and provide better outcomes.

Zetema PanelistZetema Panelist In Favor

There is little evidence that Medicaid MCOs consistently are more cost-effective than traditional FFS, or that they have a better impact on health. Some of the savings have come from restrictive policies that prevent beneficiaries from getting care they need. 

Zetema PanelistZetema Panelist Against

States that have made upfront investments in provider networks and delivery reform, such as those in Minnesota and Massachusetts, have shown they can use Medicaid MCOs to improve care and control costs.

Zetema PanelistZetema Panelist In Favor

In reality, very few states have made or will make these investments in their Medicaid programs. Minnesota and Massachusetts historically have been outliers in their healthcare policies and investments.  

Zetema PanelistZetema Panelist Against

MCOs are flexible and can provide some services that generally aren’t available in the FFS framework, such as special chronic disease management and innovations in coordinating care across healthcare settings.

Zetema PanelistZetema Panelist In Favor

These services haven’t been widely used by Medicaid MCOs. 

Zetema PanelistZetema Panelist Against

Medicaid MCOs negotiate rates with providers, ensuring at least a minimal level of provider acceptance of payment rates. FFS Medicaid rates often are so low that many doctors refuse to treat Medicaid patients. 

Zetema PanelistZetema Panelist In Favor

To offer better rates, MCOs usually restrict the choice of doctors, while the FFS system offers a broader range of providers.

Zetema PanelistZetema Panelist Against

Medicaid MCOs are run by private companies and therefore are more efficient than FFS government programs. 

Zetema PanelistZetema Panelist In Favor

MCOs have higher overhead, generate income that could be used for treatment, pay their executives big salaries, and prioritize profit over making poor people healthy. 

Zetema PanelistZetema Panelist Against

What do you think?

Should states favor Managed Medicaid over traditional fee-for-service Medicaid to cover poorer Americans?

Should states favor Managed Medicaid over traditional fee-for-service Medicaid to cover poorer Americans?

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