Medicaid ACOs


The ACA introduced Accountable Care Organizations to Medicaid with the authorization of pediatric ACOs. Subsequently the growth of Medicaid ACOs has developed generically, influenced in large part by the state’s existing Medicaid program, its history with managed care and other delivery systems. In many states, Medicaid has a history of risk-based managed care; ACOs introduce shared savings and greater incentives.
In concept, Medicaid ACOs are similar to their Medicare counterparts. They are typically provider-led and involve an increased use of quality metric designed to focus on patient-centered care and outcomes.
Medicaid ACO and more traditional Medicaid managed care may look very similar. States continue to explore Medicaid ACOs and the opportunities to provide a Medicaid quality framework, to merge medical and behavioral health services (which may have been previously carved out), and to manage beneficiaries with multiple chronic conditions

Patient Population

Varies dramatically by state; mirrors populations covered by managed care

Typical Lead

Physician Group; Health Plans

Role of Home Health Home health providers can play a crucial role coordinating care and providing a bundle of services in the home; implementing transitions of care; and meeting identified quality metrics. Home health providers could become Medicaid ACOs
Reimbursement Model Varies by state but may include risk-based capitation and shared savings. Providers will contract directly with the ACO for their bundle of services or on a FFS basis