RESEARCH: A Guide for Health Care Advocates –Medicaid Managed Care Procurement

The Georgetown University Health Policy Institute's Center for Children and Families conducted comprehensive research on different forms of Medicaid managed care procurement. The research highlights critical components of managed care procurements:

"Procurement gives the agency a chance to strengthen its contracts with MCOs to improve access and health outcomes for beneficiaries and reduce racial and ethnic disparities." (4)

"Procurement is an opportunity for a state Medicaid agency to weed out low-performing MCOs simply by not awarding them a new contract." (5)

The research also warns against procurement processes like no-bid contracts that would award low-performing plans by allowing them to participate in Medicaid managed care marketplaces. Instead, researchers recommend a process like the one Texas uses, which requires MCOs to compete for contracts by proving their ability to deliver a high quality of care to enrollees:

"If an MCO has been performing poorly year after year, there’s little reason for the state Medicaid agency to continue to contract with it. In fact, giving that MCO another three- or five-year (or longer) contract would send exactly the wrong message: rather than being held accountable, low-performing MCOs would be rewarded with a contract extension. Fortunately, there's an alternative: a rigorous “Request for Proposal” (RFP) that asks all bidders, both incumbents and potential new entrants, for detailed performance data for the preceding three- to five-year period, combined with an evaluation system that is keyed to those answers.

Read the Full Guide Here