What is a managed care organization?

A managed care organization (MCO) is a health plan that a state pays a fixed per-member, per-month amount to deliver Medicaid benefits. Most states now enroll the majority of Medicaid members in MCOs. Where the state carves transportation into managed care, each MCO is responsible for members' rides and usually subcontracts the work to an NEMT broker, though some plans manage provider networks directly.

Why MCOs matter for NEMT

In a managed-care state you may need to be credentialed with several brokers, one per MCO, to reach all Medicaid members in your county. MCO contracts also change hands: when a state re-procures its managed care plans, the transportation brokers can change with them, which means re-credentialing and sometimes new rates. Tracking your state's MCO procurement calendar is part of running an NEMT business.

Related terms

• Capitation
• Fee-for-Service Medicaid
• NEMT Broker
• Private Pay
• Medicaid