Key result
Medicaid managed care is linked to fewer emergency visits but ~1.6% higher readmissions versus fee-for-service.
Why the study?
Although managed care organizations insure most Medicaid beneficiaries, contemporary nationwide data comparing post-discharge utilization between managed care and fee-for-service beneficiaries is lacking.
Does Medicaid managed care organization (MCO) enrollment improve 30-day post-discharge healthcare utilization in Medicaid-only beneficiaries compared to fee-for-service?
Does Medicaid managed care organization (MCO) enrollment improve 30-day post-discharge healthcare utilization in Medicaid-only beneficiaries compared to fee-for-service?
Medicaid managed care is associated with greater follow-up and lower ED visits compared to fee-for-service, but carries a concerning higher readmission risk for older adults.
Managed care enrollment in older Medicaid adults warrants caution due to readmission risk; leaves open net benefit pending causal research.
Background Although managed care organizations (MCOs) insure the majority of Medicaid beneficiaries, contemporary and nationwide data comparing post-discharge utilization between MCO and Medicaid fee-for-service (FFS) beneficiaries is lacking. Methods We conducted a cross-sectional study of 1.65 million hospital discharges among Medicaid-only beneficiaries between 2015-2019, 2021-2022. Multivariable logistic regression, adjusted for patient and utilization characteristics, estimated average marginal effects of MCO versus FFS enrollment on 30-day emergency department (ED) visits, observation stays, readmissions, and follow-up visits between MCO versus FFS beneficiaries. Analyses were stratified by age 18-49 years and 50+ years. Results Among young adults, MCO versus FFS enrollment was associated with lower probability of ED visit (AME -1.2 percentage point [pp]) and higher probability of follow-up visit (AME 10.6 pp). Among older adults, MCO enrollment was also associated with lower probability of ED visit (AME -2.2 pp) and higher probability of follow-up (AME 20.4 pp), but higher readmission risk (AME 1.6 pp). Conclusion Associations between Medicaid managed care and greater follow-up and lower ED visits signal effective care coordination, while greater readmission risk for older adults is concerning. This finding may reflect barriers to care continuity and recommended post-acute care in managed care, meriting further investigation to inform solutions.
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Morenz et al. (2026) studied this question. Medicaid managed care, compared to fee-for-service, lowered emergency visits and increased follow-ups, but increased readmission risk by 1.6 percentage points in older adults.
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