Alyssa Lane
Medicaid Managed Care (MMC) is a health insurance plan that provides Medicaid state plan benefits to enrollees through a managed care delivery system. Most Medicaid-eligible individuals are required to enroll in an MMC plan unless they are exempt or excluded. MMC plans are responsible for ensuring enrollees have access to a comprehensive range of services, including preventive, primary, specialty, ancillary, and inpatient care. Marymount Manhattan College (MMC) also offers an MMC insurance plan for students on an F-1 Visa residing in the US, which is provided by UnitedHealthcare Student Resources. This plan includes a nationwide network of providers, a modest deductible, and co-insurance.
| Characteristics | Values |
|---|---|
| What is MMC? | Medicaid Managed Care (MMC) provides Medicaid state plan benefits to enrollees through a managed care delivery system comprised of Managed Care Organizations (MCOs). |
| Who is eligible for MMC? | Most Medicaid-eligible individuals are required to enroll in an MMC Plan unless otherwise exempt or excluded. |
| How to enroll in MMC? | To enroll in MMC, individuals must first establish their Medicaid eligibility. They can then visit the website universityhealthplans.com/mmc to complete the enrollment form. |
| Benefits of MMC | MMC Plans assure enrollees have access to a comprehensive range of preventative, primary, specialty, ancillary, and inpatient services through their provider networks. |
| Additional Resources | MetroPlusHealth offers a no-cost Medically Tailored Meals program that provides healthy meals and guidance from a registered dietitian and nutritionist. |
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What You'll Learn
- MMC is short for Medicaid Managed Care
- MMC provides Medicaid state plan benefits to enrollees through a managed care delivery system
- MMC plans are responsible for assuring enrollees have access to a comprehensive range of services
- MMC students on an F-1 Visa who are residing in the US are required to enroll in the MMC insurance plan
- MMC members who receive care at NYC Health + Hospital facilities now have access to MyChart, a free secure health information portal
MMC is short for Medicaid Managed Care
Medicaid Managed Care (MMC) is a health insurance plan or system that coordinates care through a primary care practitioner. It is designed to control quality, cost, and utilization, with a focus on preventative care. MMC provides Medicaid state plan benefits to enrollees through a managed care delivery system, which includes Managed Care Organizations (MCOs). These MCOs are predominantly private for-profit or non-profit, or government plans.
MCOs provide comprehensive acute care, such as physician and hospital services, and in some cases, long-term care. They are paid a set rate per member per month for these services. MMC plans are responsible for ensuring enrollees have access to a comprehensive range of services, including preventative, primary, specialty, ancillary, and inpatient care.
As of July 2024, 42 states, including Washington, D.C., had contracted with comprehensive, risk-based managed care plans to provide care to at least some of their Medicaid beneficiaries. MMC is authorized under Section 364-j of the Social Services Law (SSL) Contracts and pays the participating providers directly for services at a capitated rate per member/per month.
While MMC has increased budget predictability for states, the impact on access to care and costs is varied. States have the flexibility to determine which populations and services to include in MMC arrangements, which leads to differences across states.
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MMC provides Medicaid state plan benefits to enrollees through a managed care delivery system
Medicaid Managed Care (MMC) is a form of health insurance that provides Medicaid state plan benefits to enrollees through a managed care delivery system. MMC is authorized under Section 364-j of the Social Services Law (SSL) in New York State (NYS) and is certified under Article 44 of the Public Health Law. This system coordinates care through a primary care practitioner and focuses on controlling quality, cost, and utilization, with an emphasis on preventive care.
MMC plans are responsible for ensuring that enrollees have access to a comprehensive range of services, including preventative, primary, specialty, ancillary, and inpatient care. These services are provided through a network of contracted providers who are paid directly by NYS at a capitated rate per member per month. As of July 2022, 36 MCO states reported covering 75% or more of all children, and a total of 282 Medicaid MCOs were contracted across these states.
While MMC is a dominant form of Medicaid delivery, states have the autonomy to decide which populations and services to include in their managed care arrangements, leading to variations across states. Additionally, states have flexibility in certain areas, such as setting provider payment rates, and may choose to offer additional benefits beyond the state's requirements.
To be eligible for MMC enrollment, individuals must first establish their Medicaid eligibility. Exemptions and exclusions may apply in certain cases, as outlined in NYS Social Services Law. MMC plans provide a mix of private for-profit, private non-profit, and government plans, with some firms operating in multiple states.
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MMC plans are responsible for assuring enrollees have access to a comprehensive range of services
Medicaid Managed Care (MMC) provides Medicaid state plan benefits to enrollees through a managed care delivery system. MMC plans are responsible for ensuring that enrollees have access to a comprehensive range of services, including preventative, primary, specialty, ancillary, and inpatient care. This is facilitated through their provider networks.
MMC plans are authorized under Section 364-j of the Social Services Law (SSL) Contracts and are paid a capitated rate per member per month by New York State (NYS). MMC plans are required to pay their participating providers directly for services, which include plan-covered services and Medicaid Fee-For-Service carve-out services.
As of July 2022, 36 MCO states reported covering 75% or more of all children through MCOs. MMC plans are the dominant delivery system for people enrolled in Medicaid, with 75% of Medicaid beneficiaries enrolled in comprehensive managed care organizations (MCOs) as of 2022. While MMC is the dominant form of Medicaid delivery, there is variation across states in terms of populations and services included in managed care arrangements.
Some limitations and challenges exist, such as posting lags and incomplete data, and it is unclear whether certain administrations will continue efforts to strengthen managed care oversight and transparency. Despite these challenges, MMC plans remain responsible for providing enrollees with access to a comprehensive range of services, and states have the flexibility to offer additional benefits beyond those required.
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MMC students on an F-1 Visa who are residing in the US are required to enroll in the MMC insurance plan
Marymount Manhattan College (MMC) requires all students enrolled for 12 or more credits to have comprehensive health insurance that will cover them for sickness or injury while attending school in New York City. This includes international students on an F-1 Visa residing in the United States, who are required to enroll in the MMC Student Health Insurance Plan (SHIP). The 2024-2025 SHIP is provided by UnitedHealthcare Student Resources and includes access to a national PPO network of providers. The plan is ACA-compliant and has a modest deductible and co-insurance. The cost is approximately $2,874 for the annual period (8/15/24 – 8/14/25), pending New York State approval.
Students who feel they have adequate existing health insurance coverage can opt out of the MMC SHIP by completing a waiver form. This is done by visiting universityhealthplans.com/MMC and following the prompts to waive MMC's insurance. Students will need to provide proof of existing insurance coverage, and once the waiver is approved, the charge for MMC's insurance will be removed from the student's MMC bill. It is important to note that this process may take up to a week for processing.
For students who choose to enroll in the MMC SHIP, they can access their health insurance ID card by logging into their account on universityhealthplans.com/MMC. The website also provides information on how to enroll and details of the plan, including dates and fees. Additionally, students can contact University Health Plans at 833-251-1711 or [email protected] for assistance with waiver, enrollment, eligibility, general benefit questions, or plan issues.
It is worth mentioning that while there are no federal insurance requirements for F1 visa holders, their schools may handle health insurance in different ways. Some institutions require all international students to purchase school-sponsored insurance, while others allow students to choose their own plan. Therefore, it is essential for F1 visa holders to follow the insurance guidelines set by their specific school to ensure they have adequate coverage during their studies in the United States.
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MMC members who receive care at NYC Health + Hospital facilities now have access to MyChart, a free secure health information portal
Medicaid Managed Care (MMC) is a health insurance plan that coordinates care through a primary care practitioner. MMC plans are responsible for providing enrollees with access to a comprehensive range of services, including preventative, primary, specialty, and inpatient care. If you are a Medicaid-eligible individual, you are likely required to enroll in an MMC plan.
If you are an MMC member receiving care at NYC Health + Hospital facilities, you now have access to MyChart. MyChart is a free, secure health information portal that allows you to access your medical records and manage your healthcare easily. It is an easy-to-use application that gives you access to various assets, such as:
- Viewing a summary of your current health issues, medications, allergies, immunizations, and preventive care all in one place.
- Scheduling appointments or requesting the clinic to contact you.
- Asking for prescription refills and receiving notifications when your medications are ready for pickup.
- Sending messages, reviewing test results, and arranging follow-ups with your doctor.
- Accessing your account on electronic devices by downloading the MyChart app.
To sign up for MyChart, you will need to verify your identity with a security code sent to your email or phone number. After entering the code, create your username and password and accept the Terms & Conditions.
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Frequently asked questions
MMC stands for Medicaid Managed Care. It provides Medicaid state plan benefits to enrollees through a managed care delivery system comprised of Managed Care Organizations (MCOs).
MMC insurance is provided by MetroPlusHealth, so you can check if your insurance provider is MetroPlusHealth.
MMC is available to Medicaid recipients who meet certain income, resource, age, or disability requirements.
You can get MMC insurance by signing up for a plan with MetroPlusHealth.
