Medicaid

Providing expertise and flexible solutions to help ensure Medicaid health plans can offer comprehensive, sustainable care for their members.

Enabling growth in your unique competitive market

Serving nearly
50%
of the managed Medicaid populationhttps://hmais.healthmanagement.com/reports/medicaid-managed-care-enrollment-for-300-plans-in-39-states-plus-ownership-and-for-profit-vs-not-for-profit-status-updated-sep-20/
Supporting
29M
lives across 39 states
Serving nearly
50%
of the managed Medicaid population1
Supporting
29M
lives across 39 states

Flexible solutions tailored to meet your Medicaid needs

CVS Health goes beyond traditional pharmacy benefits to solve the broader challenges faced in state Medicaid markets. The complexity of Medicaid beneficiaries, combined with the variability of programs and requirements among states, requires payors to partner with an experienced PBM that can expertly navigate this rapidly changing market and help deliver cost savings and quality care.

State and federal health care policy can have enormous impacts on Medicaid payors and their members. Our Government Affairs team works closely with the Executive branch, Congress, governors, and state legislators in all 50 states, including Puerto Rico and the District of Columbia, to closely monitor any proposed policy reform. Our advocacy efforts are focused on helping policy makers understand payors' perspectives about solutions to some of the toughest challenges around health care cost, quality, and access.

Our ability to tailor programs to meet client-specific objectives sets us apart and allows us to support other target initiatives. From pharmacy carve-in to value-based purchasing, preventive screenings, performance networks, and understanding the impacts of social determinants, we are dedicated to providing an outcomes-focused experience that is based on client-specific needs.

Medicaid consultative services are based on strong execution and compliance


Analytic and actuarial consultative support

Strategic planning and execution support

Federal and state policy experience

Performance measures enhancement programs

State RFP and bid assistance
Analytic and actuarial consultative support
Strategic planning and execution support
Federal and state policy experience
Performance measures enhancement programs
State RFP and bid assistance

Innovation in programs, processes, and consultative insights focused on client growth and individual strategic business plans

  • Promotes administrative cost efficiencies through process improvements
  • Core operational solutions built on a foundation of compliance excellence and transparent framework
  • Healthcare Effectiveness Data and Information Set (HEDIS) strategy and execution
  • Extensive analytic support for actuaries through our Medicaid Rate Guide reporting package

How can the Health Plan Client Engagement team help support your Medicaid business? Ask Us.

Data source, unless noted otherwise, CVS Health Enterprise Analytics, 2021.

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