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 Poorest Left Out Of Medicaid Managed Care, Government Report Warns

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.”
Indeed, 43 percent of providers said they weren’t participating in the managed care plan at the location listed by the Medicaid managed care network, the report says. Worse, “callers were sometimes told that the practice had never heard of the provider or that the provider had practiced at the location in the past but had retired or left the practice. Some providers had left months or even years before the time of the call,” OIG says.
Another 8 percent of providers that actually were involved in managed care for the poorest weren’t accepting patients, OIG found. For those managed care providers that actually were involved in Medicaid managed care, were where they were advertised to be, and were actually taking new patients, patients had to wait an average of two weeks before they could get an appointment, the report says.
“Wait times for these appointments varied widely, ranging from same-day appointments to an appointment in nine months,” the report says. “For 28 percent of providers who offered appointments, enrollees had to wait more than a month for an appointment. Ten percent of providers had wait times longer than two months.”
Only a handful of states even have requirements about speed of service for Medicaid patients, OIG says, and most of those requirements set the deadline at a month or less.
“That more than a quarter of providers were unable to offer appointments within a month raises further questions about enrollees’ ability to obtain timely access to care,” the report says.
Wednesday’s OIG report is the second time in less than three months that an independent government agency has sounded the alarm about the resurgence of health maintenance organization-style care for the nation’s poorest citizens. In late September, the Government Accountability Office found that the poorest elderly were often at a loss to find decent care at an affordable price under the new managed care regimes.
The independent results aren’t all that surprising when one realizes how far managed care has pushed into “uncharted waters,” says Neill Pruitt Jr., chairman and chief executive officer of UHS-Pruitt.
There is much about Medicaid managed care implementation that is unknown,” he tells Provider in an email, “but we do know that there are mixed cost-effectiveness and quality outcomes reported in states that implement these payment structures. Ensuring access to quality care is a must, especially for individuals needing long term services and supports.”
Bill Myers is Provider’s senior editor. Email him at wmyers@providermagazine.com. Follow him on Twitter, @ProviderMyers.
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