Safety Net Health Plans are the Backbone of Medicaid Managed Care.
Not-for-profit Safety Net Health Plans share a mission to provide high-quality health care to people with low incomes and complex health care needs. These plans steadfastly support the Medicaid program during good times and bad. In contrast, for-profit plans tend to enter and exit state Medicaid markets based on economic pressures. ACAP-member Safety Net Health Plans serve more than 30 million people with low incomes in their communities, including about 1 in 3 people in Medicaid managed care. Safety Net Health Plans partner with federal and state governments, health care providers, community health centers, and other community organizations to identify and fund innovative solutions. Many Safety Net Health Plans have been serving Medicaid enrollees for more than 30 years.
Medicaid Managed Care Ensures Access Through Strong Provider Networks.
Medicaid managed care ensures access to a network of primary care, behavioral health and specialty providers. Safety Net Health Plans participating in Medicaid must meet stringent federal and state network adequacy requirements based on geography, travel times, and specialty.
Safety Net Health Plans Emphasize Primary Care and Prevention.
Safety Net Health Plans promote timely primary and preventive care services. This helps to avoid inappropriate, costly visits to the emergency room. Safety Net Health Plans work with primary care providers to ensure that preventive services are available and used by members. Few, if any, fee-for-service programs provide such needed care coordination. Research has found not-for-profit plans such as Safety Net Health Plans are significantly more likely to perform at a higher level than for-profit health plans on measures of preventive care.
Safety Net Health Plans Drive Down Costs and Provide Continuity of Coverage for Enrollees Churning Between Medicaid and the Marketplace.
Safety Net Health Plans have a unique mission and expertise in delivering high-quality health care services to low-income individuals and vulnerable populations. Many Marketplace enrollees share characteristics with low-income enrollees in Medicaid, and some families experience “split eligibility,” with children covered in Medicaid and CHIP and parents in Marketplace coverage. “Overlap plans” that offer both Medicaid Managed Care and Marketplace coverage often charge lower premiums, driving down premiums in counties where they operate, as well as reducing the most harmful effects of “churn” by providing same-plan continuity between Medicaid and the individual market. In 2023, in 80% of rating areas with an overlap plan operating in both Medicaid and the Marketplace, that overlap plan offered either the lowest or second-lowest silver-level premium for a 27-year-old.
Safety Net Health Plans Promote Quality.
Safety Net Health Plans ensure the highest-quality health care through an ongoing commitment to transparency, quality measurement and continuous quality improvement. Safety Net Health Plans have routinely been featured in the top tier of Medicaid plan ratings developed by the National Committee for Quality Assurance. ACAP successfully advocated for a requirement for states to report on all adult behavioral and pediatric core measures to ensure that all Medicaid and CHIP enrollees receive high-quality health care.
Safety Net Health Plans Address Social Determinants of Health.
Factors beyond traditional medical care dramatically influence an individual’s health and ability to obtain and adhere to treatment. Safety Net Health Plans’ deep connections to their communities facilitate services and supports that address these issues, improving health outcomes and reducing health care costs. Initiatives range from helping members secure affordable, stable housing, to building permanent supportive housing units, and facilitating educational opportunities and employing resident community health workers. Other innovative programs include teaching courses in nutrition, supporting the availability of fresh fruits and vegetables in food deserts, addressing social isolation, and providing access to community resource centers.
Safety Net Health Plans Support Safety Net Providers.
Safety Net Health Plans work hand-in-hand with safety net providers—including community health centers, public hospitals, children’s hospitals, and primary care providers—to preserve access to care for Medicaid enrollees. Many Safety Net Health Plans were created by community health centers and safety net hospitals; some plans are still owned by providers. Safety Net Health Plans share responsibility with the provider community to deliver the best possible care to Medicaid enrollees and other vulnerable individuals, including supporting provider efforts to establish patient-centered medical homes and implementing electronic medical records systems.
Safety Net Health Plans Provide Patient-Centered Care Management and Long-Term Services and Supports.
Safety Net Health Plans have an abiding commitment to ensuring enrollees receive the top-notch care they deserve. In partnership with safety net providers, Safety Net Health Plans manage a wide range of concerns that may not be addressed by other health care delivery systems, including intensive case management programs to help enrollees who have difficulty adhering to a treatment plan. Some plans have adopted health coaching programs, extended hours, and supported patient-centered medical homes—all to meet the needs of their members. ACAP’s MLTSS and integrated Medicare-Medicaid plans furnish and coordinate long-term care services to elderly and disabled Medicaid and Medicare enrollees in their communities and in nursing facilities.
Safety Net Health Plans Integrate Medicaid and Medicare.
More than 12 million people who have Medicare coverage are also enrolled in Medicaid. These “dual eligibles” are more likely to live with multiple chronic conditions and need care coordination to maintain their health and independence. More than 40 Safety Net Health Plans serve dual eligibles through Medicare Advantage Dual-Eligible Special Needs Plans or Medicare-Medicaid Plans that operate under CMMI’s Financial Alignment Demonstration. ACAP supports these efforts and envisions the long-term sustainability of programs that integrate care for dual eligibles.
Medicaid Managed Care is Efficient, High-Quality Care.
Safety Net Health Plans coordinate the care and needs of their members in a way that reduces waste, improves efficiency, contains cost and maintains quality of care. Federal estimates peg the Medicaid managed care payment error rate at 0.00 percent, compared with 6.9 percent for fee-for-service Medicaid.4 While many states have moved high-needs populations that could benefit the most from care coordination into managed care, only about 52 percent of Medicaid spending was capitated in 2021.5 This suggests room to expand managed care, particularly for “dual eligibles,” which could generate substantial Medicaid program savings.