Today, more than three-quarters of Medicaid beneficiaries receive coverage through Medicaid managed care organizations (MCOs). Medicaid managed care was intended to improve care coordination, enhance quality, and restrain spending growth. Supporters argue that Medicaid managed care strengthens care coordination, provides budget predictability for states, and moves Medicaid away from fragmented fee-for-service systems. Critics contend that, within Medicaid, it has increased administrative complexity, weakened accountability, and facilitated financing arrangements—including provider taxes and state-directed payments—that have substantially increased federal Medicaid spending without commensurate improvements in quality or health outcomes. Unlike Medicare Advantage or commercial plans, where insurers compete for consumers or employers, Medicaid managed care is dominated by government procurement operating under a complex federalist structure that creates distinct policy and financing challenges.

The evidence on the effect of Medicaid managed care, one way or the other, remains relatively sparse.

The debate has become especially timely. Congress recently enacted significant reforms to Medicaid financing, and CMS has proposed regulations implementing those reforms that would substantially limit state-directed payments. These changes raise broader questions about Medicaid managed care’s future. Has Medicaid managed care achieved its intended goals? Should it be reformed to better align incentives and improve accountability? Or has it become a vehicle through which states shift Medicaid costs to federal taxpayers while obscuring spending and reducing transparency?

To help elevate this important policy discussion, Paragon is launching a symposium examining one central question: Should Medicaid Managed Care Be Reformed—or Eliminated?

We invite researchers and policy experts to submit essays of approximately 1,500 to 2,000 words arguing for retaining, reforming, scaling back, transitioning existing models to ones with more patient empowerment, or eliminating Medicaid managed care. We welcome submissions examining Medicaid managed care’s impact on quality, access, health outcomes, cost containment, provider taxes, state-directed payments, and other financing arrangements, as well as proposals for meaningful reform. Authors of essays selected for publication will receive a $500 honorarium.

Please e-mail submissions to apply+managed-care-essay@paragoninstitute.org with the subject
line: “[Your Name] Future of Managed Care Symposium Submission”