The Association for Community Affiliated Plans (ACAP) thanks you for providing us the opportunity to respond to your request for information on best practices for delivering high quality care in an effective and efficient manner in Medicaid managed care. ACAP is an association of 58 nonprofit and community-based Safety Net Health Plans (SNHP). Our member plans, located in 24 states, provide coverage to more than 12 million individuals enrolled in Medicaid, the Children’s Health Insurance Program (CHIP), Medicare Special Needs Plans for dually-eligible individuals and Qualified Health Plans. ACAP plans currently serve approximately one-third of Medicaid and CHIP enrollees who receive coverage through riskbased managed care. ACAP plans are members of their communities, partnering with states through good times and bad to improve the health and well-being of their members who rely upon the Medicaid and CHIP programs.
The Medicaid and CHIP programs are vital components of the U.S. health care system, providing care and critical services to more than 80 million Americans. States are increasingly turning to managed care organizations to deliver efficient, value-based, patient-centered care to their Medicaid recipients because Medicaid managed care provides high-quality, coordinated care to its enrollees and predictability to state and Federal budgets. Medicaid managed care plans are held to high standards of quality measurement, reporting, and improvement. All plans are required to have quality improvement programs. It is important for Federal and state policy makers to note that no comparable Federal requirements exist to measure and improve quality of care in Medicaid fee-for-service or primary care case management, the other major delivery systems in the Medicaid and CHIP programs.
ACAP’s diverse Safety Net Health Plan members provide many examples of best practices which are referenced throughout this response. However, a “best practice” for one plan may not work for another that serves a different population or geographic area. Just as the state-directed nature of the Medicaid program allows for regional and local experimentation and solutions tailored to specific issues, managed care does not – and should not – operate uniformly throughout the nation.