
How do States Deliver Care in Medicaid?
States administer their Medicaid programs and determine how to deliver care. Federal law requires states to provide certain “mandatory” benefits and allows states the choice of covering other “optional” benefits. Comparisons across states should consider differences in their benefits and care delivery approaches. For example, some states choose to deliver Medicaid health benefits and additional services through managed care organizations. States may also use waiver authorities, such as 1915(b), 1915(c) waivers, or section 1115 demonstrations to offer coverage or extend benefits to a target population. The following data show examples of the ways states can vary in benefit coverage and how they deliver care.
How do States Deliver Care in Medicaid? |
Examples of the ways states can vary in benefit coverage and how they deliver care. |
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National Context |
Total National Medicaid Managed Care Enrollment
Enrollment in Any Type of Managed Care Plan by State
National Percentage of Medicaid Enrollees by Care Delivery ApproachNational Percentage of Medicaid Enrollees by Care Delivery Approach Pie chart breaking down by percentage of comprehensive managed care vs non-comprehensive managed care vs fee-for-service
Percentage of Medicaid Enrollees in Comprehensive Managed Care Plans by StatePercentage of Medicaid Enrollees in Comprehensive Managed Care US Map with the categories and values:
Managed Long-Term Services and Supports (MLTSS) Plans by StateManaged Long-Term Services and Supports (MLTSS) Plans by State US Map breaking down states by MLTSS or Comprehsive Managed Care Includes LTSS or Both of these or None
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Source: 2019 Managed Care Enrollment Report Note: Comprehensive managed care plans provide all acute and primary medical services. |
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How do States Deliver Care in Medicaid? |
Examples of the ways states can vary in benefit coverage and how they deliver care. |
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National Context |
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![]() 1915(c) Waivers and Section 1115 Demonstrations for Home & Community-Based Services US Map showing states broken down into 1915c Waiver vs Section 1115 Demonstration vs 1915c Waiver and Section 115 Demonstration
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Source: CMS’s analysis of administrative data. Notes: This map reflects whether states have one or more 1915(c) waivers or a section 1115 demonstrations as of June 2021. States may deliver HCBS through State Plan Amendments and/or other waiver authorities. |
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How do States Deliver Care in Medicaid? |
Examples of the ways states can vary in benefit coverage and how they deliver care. |
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National Context |
Source: Statewide Transition Plans Notes: This map reflects the approval status of states’ statewide transition plans (STPs) for home and community-based services (HCBS) as of July 31, 2021. The STP is the vehicle through which states describe how they will comply with the new requirements for home and community-based settings in the HCBS final regulation effective March 17, 2014. States have until March 17, 2023 to come into compliance. All states have submitted at least one STP. Initial approval requires: (1) identification in the STP of all settings subject to the rule; (2) a systemic assessment of state statutes, regulations, and policies, necessary remediation strategies for those resources; (3) a public comment period and a summary of responses to comments received on the STP. Final approval requires: (1) a summary of completed and validated site-specific assessments, with remediation strategies and timelines for resolution; (2) a plan for identifying and evaluating those settings; (3) a process for communicating with beneficiaries who are currently in settings that cannot or will not come into compliance with the settings criteria by the end of the transition period; (4) a description of ongoing monitoring and quality assurance to ensure all settings remain in full compliance with the settings criteria. States must post the updated version of the STP for a minimum 30-day public comment period prior to final approval. For more information about STPs and updates to approval status that occurred after July 2021, please visit the Statewide Transition Plans webpage. CMS guidance for states concerning statewide transition plans may be found here: https://www.medicaid.gov/medicaid/home-community-based-services/guidance/home-community-based-settings-requirements-compliance-toolkit/index.html. |
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How do States Deliver Care in Medicaid? |
Examples of the ways states can vary in benefit coverage and how they deliver care. |
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National Context |
Percentage of Dual Eligible Beneficiaries in Integrated Care Programs by State showing which states fall into which range of percentages and which states have no integrated care:
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Source: Medicare-Medicaid Coordination Office This measure reports the percentage of dual eligible beneficiaries in integrated care programs by state as of July 2020. Integrated care programs include: Programs of All-Inclusive Care for the Elderly, Medicare-Medicaid plans, Medicare-Medicaid demonstration programs, certain integrated dual eligible special needs plans, and total cost of care fee-for-service. |
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How do States Deliver Care in Medicaid? |
Examples of the ways states can vary in benefit coverage and how they deliver care. |
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National Context |
Section 1115 Substance Use Disorder (SUD) and Serious Mental Illness (SMI) Demonstrations US Map showing which states have Demonstrations of SUD, SUD and SMI, and Neither SUD nor SMI:
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Note: This map reflects whether states have approved section 1115 substance use disorder and/or serious mental illness and serious emotional disturbance (SMI-SED) demonstrations as of May 2021. |