Accelerating managed care complexity and regulatory requirements are increasing administrative friction, creating a strong business case for AI that targets real operational and clinical bottlenecks.

Medicaid was established in 1965 as a system of federal matching funds for states to deliver health care to low-income Americans. Initially, all states paid directly for medical services, but they ...

Managed care organizations (MCOs), which primarily offer medical and pharmaceutical benefit plans, play a central role in the United States healthcare system. By managing health plans for individuals ...

In American healthcare, Medicaid presents significant challenges, particularly regarding inpatient stay approvals. In recent years, Medicare and the Two-Midnight Rule have dominated discussions around ...

The following information was released by the Federation of American Scientists:. Text by Y. Tony Yang. A wheelchair user with complex care needs submits a prior-authorization request that her ...

In 2025, managed care organizations (MCOs) face a crossroads with political and regulatory landscapes in transition. The Republican-backed "One Big Beautiful Bill Act" in place may reduce the US ...

To mark the 30th anniversary of The American Journal of Managed Care (AJMC), each issue in 2025 includes a special feature: reflections from a thought leader on what has changed—and what has not—over ...

Minnesota is reviewing Medicaid spending to fight fraud, but the scope is limited Managed care organizations responsible for billions of dollars in social services spending have been left out of a key ...

In our state, managed care organizations (MCOs) safeguard access to critical and comprehensive health care services for nearly one in two New Mexicans. Under the Medicaid Turquoise Care program, it is ...

The Navajo Nation is looking to launch its own managed care organization in New Mexico through an agreement with Molina Healthcare. The managed care organization has been in the works for the past ...

Dedicated cyber solution offers up to $25 million in primary and excess coverage for managed care organizations TAMPA, Fla.--(BUSINESS WIRE)-- MSITM, one of the largest independent managing general ...

Within the first six months of President Trump’s second term, his Administration and the GOP have already implemented significant policies that are reshaping health care in the United States. Through ...