Medicaid has grown by millions of lives in recent years, largely as a result of Medicaid expansion under the Affordable Care Act. The number of states expanding their Medicaid programs under the ACA or in waivers sanctioned by the Centers for Medicare & Medicaid Services has increased to 31 plus the District of Columbia. That growth changes Medicaid's patient mix significantly in the expansion states, where Medicaid effectively becomes an income-based healthcare safety net. This report explores MCO growth, plan penetration, pharmacy control by MCOs, state-based care coordination efforts, and the impact of the ACA expansion to stakeholders, and includes updated Decision Resources Group enrollment data as of July 2015.

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