Noteworthy News

Access to Care Lacking for New Medicaid Patients

hhsOIGThe Office of the Inspector General of the U.S. Department of Health and Human Services (OIG) has found that even as Medicaid enrollment surges as a result of Affordable Care Act reforms, many of the newly insured are having trouble gaining access to care.

The problem, outlined in a new report, is that states are not doing enough to ensure that the managed care organizations serving most new Medicaid patients have adequate provider networks.  As a result, some patients are waiting months for doctors’ appointments or must travel long distances for care.

The review, undertaken at the request of Congress, found that

State standards for access to care vary widely. For example, standards range from
requiring 1 primary care provider for every 100 enrollees to 1 primary care provider for
every 2,500 enrollees. Additionally, standards are often not specific to certain types of providers or to areas of the State. States have different strategies to assess compliance with access standards, but they do not commonly use what are called “direct tests,” such as making calls to providers. Further, most States did not identify any violations of their access standards over a 5-year period. The States that found the most violations were those that conducted direct tests of compliance. Among the States that identified violations, most relied on corrective action plans to address the violations; six imposed sanctions. Finally, our review found that CMS provides limited oversight of State access standards.

To address these problems, the OIG recommended that

… CMS (1) strengthen its oversight of State standards and ensure that States develop standards for key providers, (2) strengthen its oversight of States’ methods to assess plan compliance and ensure that States conduct direct tests of access standards, (3) improve States’ efforts to identify and address violations of access standards, and (4) provide technical assistance and share effective practices.

The Centers for Medicare & Medicaid Services (CMS) largely agreed with the OIG’s recommendations.

To see the entire OIG report, go here.

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