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GAO Releases Medicaid Managed Care Utilization Analysis

The Government Accountability Office (GAO) has released an analysis of services used by patients enrolled in Medicaid managed care plans. In the past, managed care service utilization data, or encounter data, submitted by states to the Centers for Medicare & Medicaid Services has been unreliable. Recent evidence has shown improvements in the data’s reliability, allowing for meaningful analysis. As more states turn to managed care for their Medicaid populations, these types of data can help us fully understand how beneficiaries are being managed in this delivery system. Using 2010 encounter data from 19 states, GAO examined the services  provided in four categories:

  • evaluation and management, such as office visits and emergency department services
  • procedures, such as surgery and ophthalmology
  • ancillary, such as pathology and lab services
  • other services, such as oxygen therapy

GAO found that on average, adults used more services than children. Adults, based on their state of residence, used 13 to 55 services per year, while children averaged just 6 to 16 services annually. Further, GAO found that service utilization varied by state and length of enrollment. Beneficiaries with partial-year enrollment utilized more services than full-year beneficiaries.

Medicaid managed care has become an increasingly popular approach to provide coverage to Medicaid beneficiaries, with an estimated 65 million beneficiaries covered through managed care plans in 2014.

Contact Zina Gontscharow, MPP, policy analyst, at or 202.585.0113 with questions.


About the Author

Matt Buechner is the policy and advocacy associate for America's Essential Hospitals.

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