Medicaid Managed Care Organizations
GPTKB entity
Statements (56)
| Predicate | Object |
|---|---|
| gptkbp:instanceOf |
gptkb:insurance
|
| gptkbp:admission |
children
pregnant women elderly people with disabilities low-income individuals |
| gptkbp:covers |
over 70% of Medicaid enrollees
|
| gptkbp:criticizedFor |
prior authorization requirements
limited provider networks potential for under-service |
| gptkbp:establishedIn |
1970s
|
| gptkbp:example |
gptkb:Aetna
gptkb:Molina_Healthcare gptkb:Anthem gptkb:Centene gptkb:WellCare gptkb:UnitedHealthcare |
| gptkbp:excludes |
Native American populations
dual eligibles long-term care recipients |
| gptkbp:expansionIn |
1990s
|
| gptkbp:goal |
improve health outcomes
increase preventive care utilization reduce unnecessary hospitalizations |
| https://www.w3.org/2000/01/rdf-schema#label |
Medicaid Managed Care Organizations
|
| gptkbp:mayInclude |
gptkb:Provider_Sponsored_Organization
gptkb:Preferred_Provider_Organization Health Maintenance Organization |
| gptkbp:operatesIn |
gptkb:United_States
|
| gptkbp:provides |
prescription drugs
primary care specialty care behavioral health services preventive care vision care dental care hospital services |
| gptkbp:providesService |
Medicaid beneficiaries
|
| gptkbp:purpose |
improve care coordination
control healthcare costs manage Medicaid health benefits |
| gptkbp:receiveFundingFrom |
Medicaid program
|
| gptkbp:regulates |
gptkb:Centers_for_Medicare_&_Medicaid_Services
state governments |
| gptkbp:subject |
federal regulations
state regulations quality reporting requirements external quality review grievance and appeals processes network adequacy standards |
| gptkbp:subjectOf |
policy debates
|
| gptkbp:targetUser |
gptkb:state_Medicaid_agencies
|
| gptkbp:type |
Managed Care Organization
|
| gptkbp:uses |
capitated payment model
|
| gptkbp:bfsParent |
gptkb:Medicaid_program
|
| gptkbp:bfsLayer |
5
|