MANAGEMENT UPDATE.

MEDICAID MANAGED CARE CONCERNS

The HHS OIG website reports that 81% of Medicaid enrollees currently receive at least part of their care through managed care. That’s why a March 21 video posted by the Inspector General for the US Department of Health and Human Services for use by consumers is of significance. It highlights some of the concerns its work has revealed with inappropriately denied service authorizations and the denial of payments for Medicaid managed care medical services, and Medicare Advantage.

The short video provides basic advice to Medicaid enrollees about reading and understanding the plan they have, and asking questions of health care providers or state Medicaid enrollee assistance lines. It also encourages individuals to report problems to their state Medicaid agency if they believe their managed care plan is stinting on care or failing to provide services promised in plan materials.

Noting that the IG has targeted oversight of managed care as a priority area, the website links to the OIG August 2023 strategic plan for Medicaid and Medicare. Under a resource tab, it also lists a countless number of reports that it has produced about Medicaid managed care issues in the states. (There is also a parallel tab, and similarly long list about Medicare Advantage.)

According to a recent article about “Medicaid managed care spending in 2023” from Health Management Associates, managed care spending “has increased at a compounded annual growth rate (CAGR) of 14.2% since FFY 2007”. That compares to 6.5% growth in total Medicaid spending.