Medicaid Managed Care Program STAR and Form

Instructions and help about Medicaid Managed Care Program STAR And

In the 1970s, the concept of managed care was formally introduced to the Medicaid program. And since then, many states have used state plan amendments or their waiver authority to introduce managed care into their Medicaid system. Using either a state plan amendment or waiver, and typically an 1115 waiver, states can authorize the use of managed care organizations, or MCOs, to manage the provision of services to their Medicaid population.   The most common type of managed care structure is a comprehensive risk-based managed care arrangement. This is where a state contracts with an MCO, paying them a fixed dollar amount per member, per month, or PMPM, to cover a set of services including primary care and hospitals. And if a state includes, or carves in, optional services such as dental, pharmacy, and behavioral health to their MCO contract, then MCOs have the capacity to integrate care for their members. In this arrangement, MCOs are responsible for establishing provider