Share of Medicaid Enrollees in Managed Care

CMS's description

2024 Share of Medicaid Enrollees in Managed Care The Share of Medicaid Enrollees in Managed Care table (Table 4 in the Enrollment Report) displays the total number of Medicaid enrollees nationally, and by state and territory, as well as the number and percentage of the total in any type of managed care, and the number and percentage of the total enrolled in comprehensive managed care. 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: Number of Individuals” column represents an unduplicated count of enrollees in any Medicaid managed care program, including comprehensive MCOs, limited benefit MCOs, PCCMs, and PCCM Entities. 3. The “Medicaid Enrollment in Comprehensive Managed Care: Number of Individuals” column represents a count of Medicaid enrollees in a managed care plan that provides comprehensive benefits (acute, primary care, specialty, and any other), as well as PACE programs. It excludes individuals enrolled in a Financial Alignment Initiative Medicare-Medicaid Plan as their only form of managed care. 4. Tennessee’s 2024 data submission indicated 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 4. 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 Share of Medicaid Enrollees in Managed Care The Share of Medicaid Enrollees in Managed Care table (Table 4 in the Enrollment Report) displays the total number of Medicaid enrollees nationally, and by state and territory, as well as the number and percentage of the total in any type of managed care, and the number and percentage of the total enrolled in comprehensive managed care. 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: Number of Individuals” column represents an unduplicated count of enrollees in any Medicaid managed care program, including comprehensive MCOs, limited benefit MCOs, PCCMs, and PCCM Entities. 3. The “Medicaid Enrollment in Comprehensive Managed Care: Number of Individuals” column represents a count of Medicaid enrollees in a managed care plan that provides comprehensive benefits (acute, primary care, specialty, and any other), as well as PACE programs. It excludes individuals enrolled in a Financial Alignment Initiative Medicare-Medicaid Plan as their only form of managed care. 4. Tennessee’s 2023 data submission indicated 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 4. 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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