Medicaid Managed Care

Under the managed-care model, States are responsible for ensuring their contracted MCOs comply with Federal and State requirements and the provisions of their managed-care contracts (42 CFR §§ 438.602 and 438.608). Federal regulations also require States to document that all payment rates in managed-care contracts are based upon services that are covered in the State plan (42 CFR § 438.6(c)(4)). Federal reimbursement is available to States only for periods during which the managed-care contract meets Federal regulations (42 CFR § 434.70).