Managed Care is a way to organize payments for Medicaid where a Managed Care Organization (MCO) is contracted by a state to provide Medicaid services through a risk-based system for a pre-set premium, known as a capitation payment. This system is called "risk-based" because MCOs are at financial risk for the services outlined in their Medicaid contracts with the states, since they are responsible for contracting with providers directly. If the price contracted with the provider is greater than the annual capitation payment, then the MCO would have to absorb the loss. Since 2018, Illinois has worked toward having MCOs provide 80 percent of the state's Medicaid coverage. This shift in coverage from direct fee-for-service to managed care for Illinois Medicaid has resulted in a dramatic shift in Illinois expenditures on MCOs, as depicted in the graph below.
The following provides current spending to MCOs for the current fiscal year that includes optionable data selection for individual Managed Care Organizations: