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Affordable Care Act

Medicaid delivery needs some attention

A Wall Street Journal Editorial (May 30) outlined some pitfalls when states provide certain Medicaid benefits. This will sound complicated, but it needs to be carefully considered by Virginia as the Commonwealth moves down the path toward expanding Medicaid services.

States contract with managed-care organizations to administer Medicaid benefits. Obamacare requires MCOs to spend at least 85 percent of all taxpayer dollars on medical claims and care improvements. The rest is for overhead, marketing and profits. Most often, however, MCOs outsource the drug benefits management to a pharmaceutical benefit manager. The PBM decides which drugs are listed on a formulary, how much...

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