Risk-Based Managed Care

Risk-based managed care refers to contracts between a state Medicaid agency and managed care organizations (MCOs) in which the MCO agrees to provide comprehensive Medicaid benefits to enrolled Medicaid beneficiaries, and the state pays the MCO a fixed per-member- per-month (PMPM) premium, or capitation payment.37 MCOs either provide the care directly or arrange for the care through subcontracts. Relevant Federal Legislation or Regulation: MedicaidSee, Managed Care Organization, Social Security Act §1903(m). Defines the term Medicaid managed care organization and related requirements. 42 C.F.R. Part 438. CMS regulations on Medicaid managed care.