Medicaid Managed Care in Transition: What 2025 Procurement Trends Mean for Community-Based Providers

Community Service Board of Middle Georgia (CSBMG)
January 2026

Medicaid remained one of the most influential funding mechanisms in the United States health care system throughout 2025, even as states navigated regulatory changes, reimbursement pressures, and shifting eligibility requirements. Representing nearly one-fifth of national health care expenditures, Medicaid continued to play a critical role in financing services for individuals with behavioral health conditions, intellectual and developmental disabilities (IDD), and complex social needs (Oss, 2026). As states refined their managed care strategies, procurement activity offered a valuable lens into evolving priorities.

An examination of the most accessed Medicaid-related requests for proposals (RFPs) in 2025 highlighted a system undergoing structural transition. Rather than focusing solely on cost containment, states increasingly emphasized integrated care models, population-specific service design, and accountability for outcomes. These trends carried important implications for community-based providers, including agencies like ours, the Community Service Board of Middle Georgia (CSBMG).

Demographic Shifts Driving Managed Care Expansion

One of the most influential forces shaping Medicaid managed care was the changing composition of enrolled populations. Between 2019 and 2023, enrollment of seniors and individuals with disabilities in Medicaid managed care plans increased significantly, reflecting a growing reliance on managed care to serve individuals with higher service intensity and long-term support needs (Oss, 2026). By 2023, nearly two-thirds of Medicaid beneficiaries in these categories received services through managed care arrangements.

Several strategies contributed to this shift. Some states expanded enrollment of individuals who were eligible for both Medicare and Medicaid into integrated delivery systems, including Dual Eligible Special Needs Plans (D-SNPs). Long-term services and supports—particularly those delivered in home- and community-based settings—were also increasingly administered through managed care contracts. In addition, states continued to develop specialized managed care plans for children and youth with complex medical or behavioral health needs (Oss, 2026).

Uneven Adoption Across States

Despite consistent national growth, Medicaid managed care implementation varied widely across states. Some states enrolled only a small percentage of seniors and individuals with disabilities in managed care, while others relied almost exclusively on managed care models for these populations (Oss, 2026). Georgia remained among states with lower enrollment proportions, illustrating the diversity of Medicaid program design nationwide.

Procurement Patterns Reflect Evolving Priorities

The Medicaid RFPs that drew the greatest attention in 2025 reflected clear shifts in state purchasing strategies. States increasingly sought partners capable of delivering services to defined populations, coordinating care across systems, and meeting enhanced reporting and performance expectations. High-interest procurements emphasized:

• Specialty managed care services for children, families, and youth involved in child welfare systems
• Statewide capitated managed care models integrating Medicaid and Children’s Health Insurance Program (CHIP) services
• Risk-based managed care organization contracts prioritizing accountability and outcomes
• Integrated care models for individuals dually eligible for Medicare and Medicaid
• Behavioral health crisis coordination and medical case management services
• Justice-involved reentry initiatives aligned with Medicaid policy reform
• Technical assistance and system redesign efforts supporting behavioral health and youth service infrastructure

Together, these procurement trends illustrated a continued shift toward managed care systems that integrated physical health, behavioral health, and social services under coordinated delivery frameworks (Oss, 2026).

Considerations for Community-Based Providers

For community service boards and behavioral health providers, the evolving Medicaid managed care environment required increased strategic awareness and organizational flexibility. As Medicaid continues to serve as a primary payer for individuals with behavioral health and cognitive conditions, providers face heightened expectations related to integration, documentation, and measurable outcomes.

The 2025 landscape suggested that long-term sustainability would depend on providers’ ability to collaborate effectively with managed care entities, demonstrate value through performance metrics, and adapt services to meet the needs of specialized populations. These developments underscore the importance of workforce readiness, data capacity, and cross-sector partnerships—particularly in rural and multi-county service areas such as those served by CSBMG.

Moving Forward

As states continue refining Medicaid managed care systems, national discussions increasingly focus on innovation, access, and system sustainability. Policy forums and industry convenings in 2026 are expected to further explore emerging care models designed to better serve underinsured and high-need populations (Oss, 2026).

For CSBMG, monitoring Medicaid policy trends and procurement activity remains essential to aligning services with state priorities and ensuring continued access to quality behavioral health and IDD services across Middle Georgia.

References

Oss, M. E. (2026, January 23). The changing face of Medicaid managed care: The most downloaded OPEN MINDS RFPs of 2025. OPEN MINDS.

Centers for Medicare & Medicaid Services. (n.d.). National health expenditures fact sheet.