U.S. Department of Health & Human Services

Medicaid Managed Care

Name: Medicaid Managed Care
Creator: U.S. Department of Health & Human Services

Information on Medicaid managed care plans in Arizona, Michigan, Nevada, and New Mexico, drawn from the CMS Transformed Medicaid Statistical Information System (T-MSIS). Each record includes the state and the business name of a managed care plan.

Example records

Namelegal entity	Stateaddress	Countyaddress	Service Categoryclassification	Number Of Active Patientsquantity	Number Of Eligible Mco Patientsquantity	Number Of Providersquantity	Percent Of Eligible Patients Receiving Servicesquantity	Number Of Services Per Active Patientquantity	Number Of Active Patients Per Providerquantity	Calendar Yeartemporal	Plan Categoryclassification
All	Nevada	All Counties in State	Prenatal Ob/Gyn	16421	154694	382	0.106151499	5.392607028	43:1	2020	All
All	Nevada	All Counties in State	Prenatal Ob/Gyn	16240	148299	399	0.109508493	5.01705665	41:1	2019	All
All	Nevada	All Counties in State	Prenatal Ob/Gyn	18104	214803	373	0.084281877	7.119476359	49:1	2023	All

Use cases

Medicaid MCO Market Sizing for Healthcare Vendor Sales

A sales intelligence team at a healthcare technology company maps which managed care organizations operate in each state and county, how many active patients each plan serves, and how provider-to-patient ratios vary by service category, to prioritize outreach toward plans with high patient volume but thin provider networks.

NameStateCountyNumber Of Active PatientsNumber Of Active Patients Per Provider

KYB Verification of a Medicaid Managed Care Contractor

A fintech company onboarding a healthcare payments client cross-references the applicant's business name against known Medicaid managed care plan operators to confirm the entity is an active participant in state Medicaid programs and to assess the states and plan categories in which it holds contracts.

NameStatePlan CategoryCalendar Year

Underwriting Exposure Assessment for a Managed Care Insurer

An insurance underwriter evaluating a stop-loss or reinsurance policy for a Medicaid MCO uses patient utilization rates and services-per-patient figures across service categories to estimate claims frequency and severity, and tracks year-over-year changes to identify plans with accelerating utilization trends.

NameService CategoryNumber Of Services Per Active PatientPercent Of Eligible Patients Receiving ServicesCalendar Year