OIG: New Medicaid Beneficiaries Face Challenges Accessing Care
Federal and state officials are not ensuring new Medicaid beneficiaries have adequate access to care, according to an HHS Office of Inspector General report, the New York Times reports.
As a result, many Medicaid beneficiaries often are forced to travel long distances or wait extended periods of time to see a physician, according to the report.
Under federal rules, Medicaid managed care organizations must offer "adequate access to all services covered." However, states are left to define what "adequate" means, resulting in standards for access to care that vary widely, according to the Times (Pear, New York Times, 9/27). For example, some states enforce wait time and distance standards, while others require a minimum number of providers in a plan's network, based on the number of beneficiaries. The issue has become especially acute as of late, because about eight million U.S. residents have enrolled in Medicaid under the Affordable Care Act's program expansion (Modern Healthcare, 9/28).
HHS Inspector General Daniel Levinson said the federal government "uses a checklist to confirm that states have access standards," but it does not determine whether the standards ensure access. He added that the federal government has provided "limited oversight of state standards for access to care."
In addition, Levinson said that while states rely on insurers to determine whether plans have enough physicians, "this information is often inaccurate or out of date" because some doctors have left a plan's network or some are not seeing new Medicaid beneficiaries. Only a few states work to verify the accuracy of the information provided by insurers, according to the report.
Meanwhile, the report found that most states in the last five years have not cited any insurers for violations.
Levinson said CMS should implement and enforce improved standards for access to care. Specifically, he recommended that states:
- Check with providers to see if they are taking new Medicaid beneficiaries;
- Develop standards for access to primary care physicians and specialists; and
- Consider setting specific standards for access in urban and rural areas.
According to the Times, CMS Administrator Marilyn Tavenner generally concurred with Levinson's suggestions. Tavenner said she planned to offer "additional guidance to states" but did not specify when (New York Times, 9/27).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.