Medicaid Managed Care
State health coverage for people on low incomes, run under contract by a private insurer rather than by the state directly. The state pays the insurer a fixed rate per member and the insurer manages the care. Margins are thinner than Medicare Advantage and the customer is a state government, which makes two risks specific to this line: rate-setting (a state can hold rates below cost trend, and the insurer cannot reprice mid-contract) and redetermination -- periodic eligibility checks that can remove large numbers of members at once. Enrolment here moves with policy and the economy, not with the insurer's sales effort.
Related terms
Accounts Payable · Adjusted EBITDA · Adjusted EBITDA Ex-SBC · Administered-Only Members · ADR · ARPU
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