Medicaid Managed Care Final Rule ReleasedImage Banner

Medicaid Managed Care Final Rule Released

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Medicaid Managed Care Final Rule Released

April 28, 2016

On April 25, the Centers for Medicare and Medicaid Services (CMS) issued the Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Final Rule which updates how Medicaid works for nearly two-thirds of the 72 million beneficiaries enrolled in Medicaid managed care plans.

Primary goals of the final rule:

  • Support states’ efforts to advance delivery system reform and improvements in quality of care for Medicaid and CHIP beneficiaries;
  • Strengthen delivery of managed long term services and supports;
  • Improve the consumer experience of care and key consumer protections;
  • Align rules across types of health insurance to improve efficiency and help consumers who are transitioning between insurance type; and  
  • Increase program integrity by improving accountability and transparency. 

This final rule is the first major update to Medicaid and CHIP managed care regulations in over a decade. The provisions of the rule will be implemented in phases over the next three years, starting on July 1, 2017. CMS' press release is available here

ANCOR is working on a full analysis of the rule, which will be formally published in the Federal Register on May 6, 2016.