MCO Performance Report Cover Image

In November 2011, Kentucky enrolled approximately ninety percent (90%) of the Medicaid population in managed care, through which Medicaid managed care organizations (MCOs) are paid a fixed monthly capitated rate per enrollee and are at financial risk for recipient use and service expenditures. The MCOs are responsible for managing both physical and behavioral health services for their members. In 2015, there were five MCOs operating in all regions of the state and managing care for about 1.2 million Medicaid recipients.

Because the MCOs are risk-bearing entities they are required to be licensed by the Kentucky Department of Insurance (DOI) as an HMO or insurer and meet the applicable financial solvency requirements. As licensed insurers, the MCOs are also required to file an Annual Statement with the Department of Insurance that details assets, liabilities, revenue and expenses. The Annual Statement is a standard national reporting form so that data may be compared among reporting entities. As part of this filing, MCOs must report information on the number of members, premiums and expenses for health care services for their total business and separately for business in the Commonwealth of Kentucky, broken down by Medicaid, individual, and group plans.

This report covers publicly reported data from 2015.