MCO (Managed Care Organization)

Health plan that contracts with state Medicaid programs (or commercial sponsors) to administer benefits to enrolled members. Most state Medicaid programs are now Managed Medicaid (over 75 percent of beneficiaries). MCOs negotiate provider contracts and fee schedules separately from state Medicaid fee-for-service. A practice may be in-network with state Medicaid FFS but out-of-network with several Managed Medicaid MCOs in the same state.