OIG Report on Medicaid MCOs and Access to Care: The Real Takeaway

The recently released report by the Office of the Inspector General (OIG) at the U.S. Department of Health and Human Services calls for the need for better oversight by the Centers for Medicare & Medicaid Services (CMS) on state standards for access to care in Medicaid managed care. It discusses the variability in the state standards for network adequacy, e.g., having enough providers who will accept an area’s Medicaid patients, among other access measures.  But while this variability exists, it doesn’t mean that patients aren’t adequately accessing care according to those standards.

The fact that there are standards at all that Medicaid managed care organizations (MCOs) must meet already puts MCOs far ahead of the alternative — fee-for-service (FFS) Medicaid — for which there are no network adequacy standards or requirements whatsoever.  To put it another way, let’s pose this question: Might we ever see a similar OIG comparison report on state network adequacy requirements for FFS Medicaid?  The answer is no because these requirements simply don’t exist for FFS Medicaid.  In fact, without the networks created by MCOs, Medicaid beneficiary access to doctors would be severely restricted since many FFS providers are limiting the number of Medicaid patients they see.

One should view this report as an indication of how complex the state requirements are in ensuring access to care, and all that Medicaid managed care organizations are doing to meet them. For example, many of our member health plans provide non-emergency transportation to help their Medicaid enrollees get to the doctor’s office.  To further encourage participation in their networks, our plans also typically pay providers better rates than FFS and run pay-for-performance programs that give physicians additional payments for meeting or exceeding quality measures. And these efforts make fiscal sense, too: Medicaid managed care plans have an incentive to help people access care and keep them healthy because it reduces costly hospital and emergency room visits.

Medicaid Health Plans of America and the Medicaid managed care industry look forward to working with CMS and the states as we all strive towards the common goal of providing quality, coordinated care to our nation’s underserved while providing stability and predictability to state budgets.

Jeff Myers is the president and CEO of Medicaid Health Plans of America, the national trade association representing the Medicaid managed care industry.


Morning Consult