July 7, 2022 – The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS) has announced a new suite of resources to improve state oversight of Medicaid and Children’s Health Insurance Program (CHIP) managed care programs.

The Medicaid and Children’s Health Insurance Program (CHIP) managed care programs provide individuals with health benefits and services through managed care plans. However, to ensure that the millions of individuals receiving care through the contracted arrangements with managed care plans receive quality care, CMS and state oversight is essential. 

The new resources provided by CMS and HHS include templates, and updates on tactics to improve states reporting on their managed care programs. In addition, a new web-based portal for state reporting is available to help states improve monitoring and oversight of managed care. There are also reporting templates that provide a standard format for states to report managed care medical loss ratios and other measures. 

“Today we are taking action to strengthen the oversight and transparency of Medicaid and CHIP-managed care programs,” said HHS Secretary Xavier Becerra. “We are working hand-in-hand with states and doubling down on our efforts to improve access to health care for the millions of Americans enrolled in these programs.”

CMS Administrator Chiquita Brooks-LaSure also touted the new resources, stating, “Ensuring access to health care for people enrolled in Medicaid and CHIP is a critical priority for the Biden-Harris Administration. The tools we’re releasing today reflect the latest—and certainly not the last—step CMS is taking to increase transparency and ensure that people served through Medicaid and CHIP managed care programs are receiving high-quality, high-value care.”

To view the Medicaid and CHIP Managed Care Monitoring and Oversight Tools Informational Bulletin, click here.