Promoting Delivery System Transformation in Medicaid Through the New Medicaid Managed Care Regulations


Over 75 percent of Medicaid beneficiaries are enrolled in some form of managed care, making it the dominant mechanism for organizing, paying for, and delivering health services to Medicaid beneficiaries. The new federal Medicaid managed care rule released in April 2016 creates new opportunities for states to use managed care to improve access to high-quality, integrated care for low-income populations. A comprehensive assessment of the new rule will help state officials, federal policymakers, and insurers maximize managed care’s potential to drive delivery system and payment reform in Medicaid. Researchers with the National Health Law Program will analyze the new Medicaid managed care regulations to: describe ways that states can move forward with delivery system improvements and value-based payment; identify imprecisions in the rule that require additional guidance from the Centers for Medicare and Medicaid Services (CMS) and recommend ways to design that guidance; identify barriers or problems requiring regulatory amendments; and propose broader policies and strategies to maximize the quality and efficiency of Medicaid managed care. Project staff will also review broader Medicaid policies that inform delivery system reform. In addition, interviews with 10 to 15 individuals from CMS, state Medicaid agencies, the managed care industry, and consumer organizations will yield a broad range of perspectives on the new rule’s impact. The project is expected to increase understanding of federal Medicaid policy and assist policymakers in implementing delivery system and payment reform. The project is targeted at state and federal policymakers, including CMS staff, who are designing, implementing, or operating delivery system transformation in Medicaid; other stakeholders engaged in delivery system reform for low-income populations; and the enrollees that receive Medicaid health and health care services.

Grant Details

Grantee Organization:
National Health Law Program, Inc.
Principal Investigator:
Leonardo Cuello, J.D.
Award Amount:
Approval Date:
July 13, 2016

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