Ensuring Accountability: A New Era in Medicaid Managed Care Oversight

Though managed care is the dominant delivery system for Medicaid beneficiaries and Medicaid managed care organizations (MCOs) receive almost half of all Medicaid spending ($376 billion) annually, existing federal and state regulations do not adequately hold MCOs accountable for providing high-quality, cost-effective care. On January 24, 2025, at the 30th Annual Health Action Conference (HAC) Families USA hosted an expert panel discussion to examine mechanisms to increase transparency and accountability within the Medicaid managed care system.

At a time when policymakers are looking to address health care efficiency and affordability, policymakers and consumers should have an accurate and transparent accounting of how MCOs spend the tax dollars they receive.

Panelists describe innovative programs and lessons learned from state and federal level efforts to ensure MCO dollars are being invested in appropriate ways that lead toward improvement in care and quality to the approximately 66 million people — nearly three-quarters of Medicaid beneficiaries — served by MCOs.

The session also discusses a policy agenda released by Families USA on January 27, 2025 — Achieving Transparency, Accountability and Quality in Medicaid Managed Care: A State and Federal Policy Agenda. This policy agenda examines mechanisms to increase transparency and accountability within Medicaid managed care and offers a set of policy proposals designed to give the federal government, 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.

Panelists: 

• David Machledt, Senior Policy Analyst, National Health Law Program
• Nadeen Israel, Senior Vice President of Policy & Advocacy, AIDS Foundation Chicago
• Aditya Mahalingam-Dhingra, Chief Business Officer, Community Care Cooperative (C3)

Moderator:

• Mary-Beth Malcarney, Senior Advisor on Medicaid Policy, Families USA