NCQA’s Medicaid Health Insurance Plan Ratings 2015 – 2016

This week, our In Focus section reviews the annual Medicaid health plan ratings released in September by the National Committee for Quality Assurance (NCQA). NCQA has previously provided annual rankings and quality scores of private commercial health plans serving employers and the individual market, Medicare Advantage plans, and Medicaid managed care organization (MCO) health plans. However, for 2015-2016, NCQA has implemented a new ratings methodology, “which classifies plans into scores from 0 to 5 in 0.5 increments–-a system similar to CMS’ Five-Star Quality Rating System.” This is a shift away from outright ranking of plans against each other, and toward rating them individually on a zero-to-five scale, with NCQA stating that only those plans awarded a 4.5 or 5 are to be considered “highest-rated” For 2015-2016, only eleven Medicaid MCOs across the country were awarded a 4.5 or 5.

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