Managed Care Enrollment Summary

CMS's description

2024 Medicaid Managed Care Enrollment Summary The Medicaid Managed Care Enrollment Summary table (Table 1 in the Enrollment Report) displays each state and territory’s total number of Medicaid enrollees, total managed care enrollment, number of enrollees in comprehensive managed care, and the number of enrollees in comprehensive managed care under the Affordable Care Act’s Section VIII Expansion. 1. The “Total Medicaid Enrollees” column represents an unduplicated count of all enrollees in FFS and any type of managed care, including Medicaid-only and dually eligible individuals receiving full Medicaid benefits or Medicaid cost sharing. 2. The “Total Medicaid Enrollment in Any Type of Managed Care” column represents an unduplicated count of enrollees in any Medicaid managed care program, including comprehensive MCOs, limited benefit plans such as prepaid inpatient and ambulatory health plans, PCCMs, and PCCM Entities. 3. The “Medicaid Enrollment in Comprehensive Managed Care” column represents a count of Medicaid enrollees in a managed care plan that provides comprehensive benefits (acute, primary care, specialty, and any other), or PACE program. It excludes enrollees in a Financial Alignment Demonstration Medicare-Medicaid Plan as their only form of managed care. 4. The “Medicaid Enrollment in Comprehensive MCOs Under ACA Section VIII Expansion” column is a subset of the total reported in the “Total Medicaid Enrollment in Any Type of Managed Care” column and includes individuals enrolled in comprehensive MCOs and who are low-income adults, with or without dependent children, eligible for Medicaid under ACA Section VIII. 5. While Colorado did not report a Comprehensive Managed Care program in their 2024 data submission, the state operates Accountable Care Organization-PCCM-E collaboratives that the state considers to be comprehensive managed care. 6. Tennessee’s 2024 data submission indicated that they were unable to provide an unduplicated count of enrollees in comprehensive MCO programs. Because Tennessee operates a comprehensive MCO program and a PACE program, their reported “Total Medicaid Enrollment in Any Type of Managed Care” was used to populate “Medicaid Enrollment in Comprehensive Managed Care” in Table 1. Notes: "--" indicates the state or territory does not operate a specific program type or does not have a managed care program. Ten states (California, Michigan, Minnesota, Missouri, New Jersey, Nevada, Ohio, Oregon, Virginia, Washington) reported data for “Medicaid Enrollment in Comprehensive Managed Care” that was greater than “Total Medicaid Enrollment in Any Type of Managed Care” but did not provide an explanation for why the number was greater. Alaska, American Samoa, Connecticut, Guam, Northern Mariana Islands, and the U.S. Virgin Islands do not operate Medicaid managed care programs. For these states and territories, the “Total Medicaid Enrollees” reported in this table is total Medicaid enrollment as of June 1, 2024, from the Medicaid Budget and Expenditure System, accessed on April 23, 2025. See https://data.medicaid.gov/dataset/6c114b2c-cb83-559b-832f-4d8b06d6c1b9/. 2023 Medicaid Managed Care Enrollment Summary The Medicaid Managed Care Enrollment Summary table (Table 1 in the Enrollment Report) displays each state and territory’s total number of Medicaid enrollees, total managed care enrollment, number of enrollees in comprehensive managed care, and the number of enrollees in comprehensive managed care under the Affordable Care Act’s Section VIII Expansion. 1. The “Total Medicaid Enrollees” column represents an unduplicated count of all enrollees in FFS and any type of managed care, including Medicaid-only and dually eligible individuals receiving full Medicaid benefits or Medicaid cost sharing. 2. The “Total Medicaid Enrollment in Any Type of Managed Care” column represents an unduplicated count of enrollees in any Medicaid managed care program, including comprehensive MCOs, limited benefit plans such as prepaid inpatient and ambulatory health plans, PCCMs, and PCCM Entities. 3. The “Medicaid Enrollment in Comprehensive Managed Care” column represents a count of Medicaid enrollees in a managed care plan that provides comprehensive benefits (acute, primary care, specialty, and any other), or PACE program. It excludes enrollees in a Financial Alignment Demonstration Medicare-Medicaid Plan as their only form of managed care. 4. The “Medicaid Enrollment in Comprehensive MCOs Under ACA Section VIII Expansion” column is a subset of the total reported in the “Total Medicaid Enrollment in Any Type of Managed Care” column and includes individuals enrolled in comprehensive MCOs and who are low-income adults, with or without dependent children, eligible for Medicaid under ACA Section VIII. 5. While Colorado did not report a Comprehensive Managed Care program in their 2023 data submission, the state operates Accountable Care Organization-PCCM-E collaboratives that the state considers to be comprehensive managed care. 6. Tennessee’s 2023 data submission indicated that they were unable to provide an unduplicated count of enrollees in comprehensive MCO programs. Because Tennessee operates a comprehensive MCO program and a PACE program, their reported “Total Medicaid Enrollment in Any Type of Managed Care” was used to populate “Medicaid Enrollment in Comprehensive Managed Care” in Table 1. Notes: “--” indicates the state or territory does not operate a specific program type or does not have a managed care program. Nine states (Michigan, Minnesota, Missouri, New Jersey, Nevada, Ohio, Oregon, Virginia, Washington) reported data for “Medicaid Enrollment in Comprehensive Managed Care” that was greater than “Total Medicaid Enrollment in Any Type of Managed Care” but did not provide an explanation for why the number was greater. One of these states (Michigan) reported data for “Medicaid Enrollment in Comprehensive Managed Care” that was greater than “Total Medicaid Enrollees” but did not provide an explanation for why the number was greater. Alaska, American Samoa, Connecticut, Guam, Northern Mariana Islands, and the U.S. Virgin Islands do not operate Medicaid managed care programs. For these states and territories, the “Total Medicaid Enrollees” reported in this table is total Medicaid enrollment as of July 1, 2023, from the Medicaid Budget and Expenditure System, accessed on April 23, 2025. See https://data.medicaid.gov/dataset/6c114b2c-cb83-559b-832f-4d8b06d6c1b9/.

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