Medicaid MCOs not working in Missouri, inhibiting expansion, MO could learn from CT’s experience

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Legislators are reluctant to expand Missouri’s Medicaid program because the managed care organization (MCO)-led program not as efficient as the traditional fee-for-service (FFS) program, according to a Kaiser Health News article. In a January presentation to the MO HealthNet Oversight Committee, agency representatives noted that while hospital admissions are lower in the population cared for by MCOs, but readmissions are higher. Five out of six clinical quality measures are also worse in MCOs than FFS. In the latest contract with the three MCOs — Aetna, Centene and WellCare – Missouri is requiring the plans to take more responsibility for the health of Medicaid members, including wellness incentives. We should send MO officials CT’s experience shifting from MCOs to a care coordination-focused model – higher quality, more provider participation, and costs under control.