Medicaid enrollment has increased by 27% since the passing of the Affordable Care Act (ACA)—with the majority of these new enrollees receiving benefits from risk-based MCOs. As states continue to expand Medicaid coverage, the use of managed care plans will only continue to increase, according to a new report.
Now more than ever, it’s vital that states operating managed care programs report accurate and timely encounter data to the federal government, according to the report by Navigant. Beginning this spring, states that report deficient encounter data could lose federal matching funds, and states could pass those financial penalties to MCOs.



“Failure to collect and report Medicaid encounter claims to states and CMS can result in significant penalties for Medicaid managed care plans,” says Jason Duhon, associate director, Navigant. “Since states are likely to use Medicaid MCO data to compare performance between Medicaid MCOs, the accuracy and quality of …
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Medicaid MCOs must use caution when reporting data