Magazine article Medical Economics

OIG Report: Medicaid Managed Care Programs Need More Oversight

Magazine article Medical Economics

OIG Report: Medicaid Managed Care Programs Need More Oversight

Article excerpt

WITH UP TO 18 million new people expected to enroll in Medicaid by 2018, the Centers for Medicare and Medicaid Services (CMS) needs to exercise tighter control over the program to ensure that patients have adequate access to quality care, a new government report concludes.

After examining Medicaid managed care organizations in 33 states throughout the country, the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) found widely varying standards for access to care, ranging from one primary care provider (PCP) per 100 Medicaid enrollees to one PCP per 2,500 enrollees. In addition, standards often are not specific to certain types of providers, or to population density.

"State standards vary widely and are often not specific to providers who are important to the Medicaid population, such as pediatricians, obstetricians, and highdemand specialists," the report says. "In addition, these standards often apply to all areas within a state and do not take into account differences between urban and rural areas. Without standards for specific provider types or areas, states may not be able to hold plans accountable for ensuring adequate access to care."

The most common types of Medicaid access standards are those that limit the distance or amount of time patients have to travel to see a provider, those that require appointments to be provided in a certain period of time, and those requiring a minimum number of providers in relation to the number of enrollees.

In terms of distance to a PCP, and among the 15 states that distinguish between urban and rural areas in their standards, standards ranged from six to 30 miles in urban areas and 15 to 60 miles in rural areas. …

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