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Medicaid Managed Care Resource Repository

Last Updated on November 17, 2025

Managed care is the dominant delivery system for people enrolled in Medicaid. Like many aspects of Medicaid, understanding managed care means understanding a myriad of federal rules and state policies.

This resource repository pulls together reports, studies, federal and state policy documents and other resources that explain important features of managed care and examine the evolving Medicaid managed care landscape. It is intended to serve as a toolkit of resources that advocates can pull from as various issues concerning managed care arise in their states. It is also intended to serve as background information on topic areas discussed in the implementation timeline.

Resource Suggestions

Families USA will update this bibliography often as new resources are published. If you’d like to send us an additional resource to be published here or if you have a suggestion for other topic areas that this repository should cover, please reach out to healthpolicy@familiesusa.org.

Annotated Bibliography

  • 10 Things to Know About Medicaid Managed Care
    (KFF, February 2025): An overview of Medicaid managed care detailing the state of managed care in each of the 50 states, populations served, spending, and key reports.
  • Medicaid Managed Care Database
    (Commonwealth Fund): An online database that will allow users to see the detailed purchasing specifications that states use when buying primary care services from organizations offering comprehensive Medicaid managed care. The eight major domains contained in this database include: Payment methods and incentives; Behavioral health integration; Treatment of social determinants; Performance measurement and quality improvement; Primary care access and network adequacy; Primary care patient supports; Primary care coverage; Information sharing and use of technology.
  • Medicaid Managed Care Tracker
    (KFF, 2022): Information related to risk-based Medicaid MCOs that provide comprehensive services, including acute care services and, in some cases, long-term services and supports as well. In addition, the Tracker provides information on parent firms that own Medicaid MCOs in two or more states.
  • Achieving Transparency, Accountability and Quality in Medicaid Managed Care: A State and Federal Policy Agenda
    (Families USA, January 2025): Examines mechanisms to increase transparency and accountability within Medicaid managed care and offers a set of policy proposals designed to give CMS, states, consumers and taxpayers the tools they need to ensure the managed care system lives up to its promise to lower Medicaid costs while delivering high-quality care.
  • A Guide to Oversight, Transparency, and Accountability in Medicaid Managed Care
    (National Health Law Program, March 2025): Guide explains how advocates, beneficiaries, and others can obtain information about state’s Medicaid managed care programs and use this information to ensure that managed care companies and state Medicaid agencies are fulfilling their obligations to enrollees and taxpayers.
  • A Guide for Child Health Advocates: Medicaid Managed Care Accountability Through Transparency
    (Georgetown, July 2021): Guide intended to help child and maternal health advocates use transparency to hold MCOs accountable for their performance for children and pregnant women. The guide includes information on basic performance requirements for MCOs for children and pregnant women, what publicly available information is available on MCO performance, and actions for advocates.
  • Medicare and Medicaid: Additional Actions Needed to Enhance Program Integrity and Save Billions
    (GAO, April 2024): GAO report and recommendations to improve program integrity and oversight in Medicaid managed care. HHS estimated over $100 billion in improper payments in 2023. This report explores these improper payments and provides recommendations to improve program integrity.
  • Eligibility for long-term services and supports
    (MACPAC, March 2022): Explainer on Medicaid policies to determine eligibility for long-term services and supports (LTSS), including the “Katie Beckett pathway,” which is an optional Medicaid eligibility pathway that provides Medicaid eligibility to children with severe disabilities whose family income would ordinarily be too high to qualify for Medicaid.
  • Implementation Guide: Medicaid State Plan Eligibility Family Opportunity Act Children with a Disability(CMS): Implementation guide reviews the Family Opportunity Act Children with a Disability group, an optional Medicaid eligibility group that covers individuals who: (i) are age 18 or younger; (ii) meet the SSI program’s definition of disability for a child; and (iii) have family income that does not exceed the income standard established by the state.
  • Ensuring Access to Medicaid Services Final Rule (CMS-2442-F)
    (CMS, April 2024): The Access rule seeks to create opportunities for states to promote active beneficiary engagement in their Medicaid programs. The rule renames and expands the scope of states’ Medical Care Advisory Committees and requires states to establish a Beneficiary Advisory Council (BAC) comprised of Medicaid beneficiaries, their families, and/or caregivers.
  • Engaging Medicaid Members: New Requirements in the Medicaid Access Rule
    (State Health and Values Strategies, June 2024): Explains provisions of the 2024 “Access Rule” that require states to create and support a Beneficiary Advisory Council (BAC) composed solely of current and former Medicaid enrollees, their family members, and paid and unpaid caregivers.
  • State Strategies to Compensate Beneficiary Advisory Council Members
    (RWJF, October 2024): Discusses the need for fair compensation of Medicaid enrollees serving as Beneficiary Advisory Council members. Provides strategies for thoughtful design on compensation to promote partnerships between states and community members to strengthen the Medicaid program for all enrollees.
  • Managed Care Sanctions: An Important Tool for Accountability
    (National Health Law Program, December 2022): Report reviews Medicaid managed care contracts from nine states to determine what sanctions each state had available; compares potential sanctioning powers in contracts to actual sanctions imposed, showing that states only use a fraction of their sanctions power to hold MCOs accountable.
  • Value-based payment
    (MACPAC, March 2020): Provides background on various MACPAC research on Medicaid VBP models.
  • What is the Centers for Medicare and Medicaid Services’ New AHEAD Model?
    (KFF, January 2024): Describes the Advancing All-Payer Health Equity Approaches and Development (AHEAD) model, an 11-year program (2024 – 2034) offering states the opportunity to leverage federal funding to make broad changes in the way health care is provided and paid for. With this model, CMS aims to reduce the rate of growth in health care spending, improve people’s health, and reduce disparities in health outcomes.