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Industry Landscape
The Medicaid industry is currently undergoing significant transformation, driven by increasing enrollment, evolving regulatory requirements, and the growing need for cost-effective and value-based care. States and Managed Care Organizations (MCOs) are focusing on leveraging data analytics, digital health technologies, and innovative care models to improve member outcomes, reduce administrative waste, and address social determinants of health. The industry faces challenges related to budget constraints, regulatory compliance, and the need to adapt to changing demographics and health needs.
Total Assets Under Management (AUM)
Medicaid Enrollment in United States
~92.2 million
(4.6% CAGR)
- Increased federal funding
- State expansion initiatives
- Aging population
Total Addressable Market
680 billion USD,
Market Growth Stage
Pace of Market Growth
Emerging Technologies
AI-Powered Predictive Analytics
AI-powered predictive analytics enables MCOs to identify high-risk members, personalize interventions, and optimize resource allocation for improved health outcomes and cost savings.
Blockchain Technology
Blockchain technology enhances data security and interoperability, streamlining administrative processes, reducing fraud, and improving care coordination among providers within the Medicaid ecosystem.
Telehealth & Remote Monitoring
Telehealth and remote patient monitoring expand access to care, particularly for underserved populations, enabling timely interventions, reducing hospital readmissions, and improving member engagement in their health management.
Impactful Policy Frameworks
Ensuring Access to Coverage in Medicaid and CHIP (2024)
This rule aims to improve access to healthcare coverage for eligible individuals by simplifying enrollment and renewal procedures in Medicaid and the Children's Health Insurance Program (CHIP).
The rule mandates states to implement strategies that streamline enrollment and renewal processes, reducing administrative burdens and improving member retention for MCOs.
CMS Interoperability and Prior Authorization Final Rule (CMS-0094-F)
This rule promotes seamless data exchange and reduces administrative burdens by standardizing prior authorization processes, which will improve care coordination and access to care for Medicaid beneficiaries.
The Interoperability and Prior Authorization Final Rule increases the burden on MCOs to demonstrate improved interoperability, but will drive down costs and improve patient care in the long run.
Medicaid and CHIP Managed Care Final Rule (CMS-2439-F)
This rule updates regulations for Medicaid and CHIP managed care programs to strengthen beneficiary protections, promote health equity, and improve the quality of care delivered through managed care plans.
This rule holds MCOs accountable for addressing health equity and improving outcomes for underserved populations, creating opportunities for Agilian to offer specialized consulting services.
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