Poorest Left Out Of Medicaid Managed Care, Government Report Warns

Just when you thought MLTSS couldn’t get more convoluted, Bill Myers published this eye opening report on 12/12/14 in Provider:

States and federal agencies have to do a better job of regulating new Medicaid managed care plans because patients are having trouble getting the care they need, a new government report finds.

Staff from the U.S. Department of Health and Human Services Office of Inspector General (OIG) says they randomly called some 1,800 Medicaid providers to try to set up appointments for poor patients. Fifty-one percent of the providers “could not offer appointments” for a variety of reasons, OIG says in a new report.
“When providers listed as participating in a plan cannot offer appointments, it may create a significant obstacle for an enrollee seeking care,” the 31-page report says. “Moreover, it raises questions about the adequacy of provider networks—it suggests that the actual size of provider networks may be considerably smaller than what is presented by Medicaid managed care plans. It also raises questions about whether these plans are complying with their states’ standards for access to care.”

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