This is a self-paced course for Medicaid health plan staff who are new to the space. It explains the structure of the Medicaid program, how managed care fits in, the role of state agencies, the contract and procurement process, and how plans engage with members, providers, and the state.
Duration: 1 hour
CEU credits in the Medicaid_Expert progam: 1
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Who is this course for?
New staff at Medicaid Managed Care Organizations (MCOs)
What will I learn?
The course answers these key questions:
1. What is Medicaid, and who does it serve?
2. How is Medicaid funded and structured?
3. What are the differences between Medicaid, Medicare, and commercial insurance?
4. Why is Medicaid important to the U.S. healthcare system?
5. What is Medicaid managed care?
6. What services do managed care plans deliver under Medicaid?
7. What is the role of care coordination in managed care?
8. What does it mean to have an at-risk capitation contract?
9. What is the role of the state Medicaid agency?
10. How do states monitor plan performance and quality?
11. What is an EQRO, and what do they do?
12. What reports do plans typically submit to the state?
13. How do Medicaid managed care procurements work?
14. What is an RFP in the Medicaid context?
15. What happens after a health plan wins a contract?
16. How are contracts structured between states and MCOs?
17. How do health plans support member services and communication?
18. What is the provider network, and how is it managed?
19. How do MCOs handle grievances and appeals from members?
20. What are common plan deliverables related to operations and oversight?
