Medicaid is a critical safety net, providing coverage and access to care for Americans, including children, pregnant women, people with disabilities, older adults and low-income working families. Through coordinated care and strong program integrity safeguards, the program helps families afford care and access the services they need while delivering better health outcomes for beneficiaries while ensuring responsible use of taxpayer dollars and stability for communities and states.
Medicaid Helps Coordinate Care and Improve Efficiency
Medicaid is a joint effort by federal and state governments to cover healthcare services. States use a range of tools to ensure quality care, including Medicaid managed care, a partnership between state governments and health insurance plans, to provide accountability and comprehensive health coverage to Medicaid enrollees.
Managed care is the predominant way state Medicaid programs provide healthcare services to people with Medicaid with 75% of all Medicaid beneficiaries enrolled in a Medicaid managed care organization (MCO). MCOs work closely with states to improve quality and outcomes for patients and provide budget predictability for states.
Medicaid provides essential services to millions of individuals and families with complex and ongoing health needs, including care for mental health and substance use disorders, maternal and infant health and home- and community-based services for older adults and people with disabilities.
Medicaid Prevents and Addresses Waste, Fraud and Abuse
Medicaid’s operational structure is designed to ensure care is accountable and sustainable. This includes a continuous, multi-layered system to prevent, detect and address waste, fraud and abuse. Federal agencies set standards and provide oversight, states implement and enforce program safeguards, MCOs and healthcare providers carry out day-to-day integrity work and independent government entities add further accountability.
This system delivers comprehensive oversight of eligibility redeterminations and enrollee verification, patient and provider screening, service verification, payment review, audits and external oversight. MCOs also operate program integrity units, investigate suspected fraud and report findings to states. States continue to improve and modernize their program integrity tools, shifting from reactive claims review to proactive, data-driven fraud detection and prevention.
These initiatives are working – in FY 2024, there were more than 1,000 convictions and $1.4 billion in recoveries by state Medicaid Fraud Control Units. By delivering accountability and financial oversight for states and taxpayers, these important safeguards ensure that Medicaid dollars are spent as intended on healthcare services and quality improvements for beneficiaries.
Medicaid Improves Outcomes for Patients and Communities
By pairing strong oversight with a focus on access and quality, Medicaid helps ensure resources are used responsibly while delivering what matters most: better care, better outcomes and greater stability for patients and communities.
Studies have found that Medicaid enrollees have significantly better access to care than people who are uninsured and are less likely to postpone or avoid care because of cost. Further, Medicaid expansion has been shown to increase access to care, improve health outcomes and provide greater financial security for patients and providers.
The Modern Medicaid Alliance and its partners will continue to work to ensure the Medicaid program remains strong, accountable and sustainable for the millions of Americans who depend on it.