Strategic Support for Medicaid & CHIP Managed Care Programs
Highlights
- As states shift to managed care delivery models for their state Medicaid and CHIP, CMCS needs to ensure these programs deliver compliant, quality care.
- Abt is applying our Medicaid and CHIP programmatic expertise and our technological solutioning to help CMCS and its partner states monitor and oversee these programs.
- The work will continue through 2027.
The Centers for Medicare and Medicaid Services (CMS) is the largest provider of health insurance in the United States. Two of CMS’ most impactful programs are Medicaid and the Children’s Health Insurance Program (CHIP), which provide essential health care coverage for over 90 million persons. Overseen by the Center for Medicaid and CHIP Services (CMCS) the percentage of Medicaid and CHIP enrollees covered by comprehensive managed care organizations (MCOs) increased from 47 percent to 72 percent between 2010 and 2020. As states continue their shift to managed care delivery models for their state Medicaid and CHIP programs, CMCS needs to ensure that these programs deliver quality care, are compliant with federal regulations, and have the tools needed to do both. In support of CMS, Abt provides strategic technical assistance to CMCS and states as they operate managed care programs in support of the CMCS’ Strategic Vision for the Medicaid and CHIP programs.
Recognizing that states are in various stages of strengthening their managed care and evolving their integrated delivery systems, Abt is applying state-of-the-art approaches to ensure all programs and policies deliver high quality care for all beneficiaries. Through this national work, Abt is:
- Providing technical assistance to CMS, states, and managed care entities to help ensure compliance with applicable requirements.
- Reviewing managed care contract actions submitted by states.
- Designing and executing a data-use strategy to organize, standardize, and utilize managed care data from multiple sources to effectively monitor and evaluate performance of Medicaid and CHIP managed care programs.
- Developing, reviewing, and disseminating new and existing tools and resources that will support the development and execution of Medicaid and CHIP integrated delivery systems.
- Implementing business process improvements to ensure CMS efficiently executes its managed care activities.
- Creating informational/educational materials as well as updated policy guidance for Medicaid.gov.
These efforts will improve CMS’ and states’ ability to ensure managed care and other delivery systems are compliant while serving the needs of beneficiaries.