Projects

Medicaid and CHIP Managed Care: Tools and Technical Assistance to Support Federal and State Oversight

2012-2023

Project Overview

Objective

To strengthen federal and state oversight of Medicaid and the Children’s Health Insurance Program (CHIP) benefits delivered through managed care, which is the dominant care delivery system in most states.

Project Motivation

This project supports the Centers for Medicare & Medicaid Services as it expands its capacity and capabilities for oversight of Medicaid and CHIP managed care. By supporting CMS in its partnership with states, the project helps advance the agency’s goals for these programs, including expanding access to care, ensuring high-quality care, and improving health equity.

Prepared For

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Division of Managed Care Policy

Mathematica is developing new tools and guidance, analyzing managed care data, and providing one-on-one technical assistance to states to extend CMS oversight operations and advance its vision of a systematic, data-driven approach to overseeing managed care.

As the dominant delivery system for Medicaid and CHIP, managed care has enormous potential to improve access and quality of care, lower cost growth, and achieve better health outcomes for enrollees, including improved health equity. Achieving these goals depends on strong oversight of managed care plans and providers’ performance. Mathematica and CMS have been working together for the past 10 years to achieve these ambitious goals.

To advance these goals, this project delivers a wide range of activities to support CMS and state Medicaid and CHIP agencies in conducting rigorous monitoring and oversight of managed care program and plan performance. The activities and deliverables include:

  • Thought leadership to develop and advance CMS’s vision of robust federal oversight balanced with the need for state flexibility
  • Innovative data collection tools and review tools related to contract and rate approvals; enrollment; managed care program operations; readiness reviews; medical loss ratios; state directed payments; network adequacy and access standards; appeal, grievance, and state fair hearings; and quality standards.
  • Virtual convenings and learning materials to reinforce oversight goals and exemplary state practices.
  • One-on-one assistance for state Medicaid officials on program design, operations, and management.

Related Staff

Jenna Libersky

Jenna Libersky

Principal Researcher

View Bio Page
Rebecca Sweetland Lester

Rebecca Sweetland Lester

Researcher

View Bio Page
Debra  Lipson

Debra Lipson

Senior Fellow

View Bio Page
Erin Behrmann

Erin Behrmann

Managing Consultant

View Bio Page
Kelsey Cowen

Kelsey Cowen

Managing Consultant

View Bio Page
Erin Weir Lakhmani

Erin Weir Lakhmani

Senior Researcher

View Bio Page
Michaella Morzuch

Michaella Morzuch

Researcher

View Bio Page
Amy Wodarek O’Reilly

Amy Wodarek O’Reilly

Principal Managing Consultant

View Bio Page
Ryan Stringer

Ryan Stringer

Researcher

View Bio Page
Susan Williams

Susan Williams

Senior Researcher

View Bio Page