Medicaid Medicare What's Buzzing

Access to care a serious problem in Medicaid managed care plans

Written by Diane Archer

A recent report by the HHS Office of the Inspector General reveals that private companies offering Medicaid managed care are failing to ensure adequate access to care to their enrollees. Each state has its own law regarding standards for access to care in managed care plans—both appointment availability and wait times for appointments—and different ways of determining compliance with standards.

Given that the federal government is paying the full cost or a significant part of the cost of these plans, the report makes a strong case for the federal government to step in and create a baseline standard with enforcement mechanisms for managed care plans in every state.

Disturbingly, the OIG found that appointments were not available from more than half of providers (51 percent) surveyed. More than one-third of providers (35 percent) surveyed were not even at the office listed by the plan. Another 8 percent were not in the plan’s network.  And yet another 8 percent were simply not taking new patients.

Of the providers with whom appointments were available, the median wait time was two weeks and more than 25 percent of them required enrollees to wait more than a month for an appointment.The OIG surveyed 1,800 providers of care, both primary care physicians and specialists.

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2 Comments

  • VERY TRUE !
    If you look into ONE OF THE WORST (COVENANT HEALTH CARE) they are called Non-Profit ( Big Laugh) grabbing up all the Doctors and Hospitals and paying their CEO , Anthony Spezia, in Knoxville Tn 1.877% of the GROSS INCOME (they call expenses) who now got a $1.6 million dollar annual salary ! Guess where it goes from there when they have all of them signed up. Then making a lot of changes of co-pay for everything outside the Insurance coverage. Just paid $13.00 for co-pay for blood check !

  • There has to be a national standard of care. That all health insurers must follow. An the health care industry must be willing to accept wage and price controls. The health care industry is one fourth of our economy. This would have ripple effect through our whole economy. An help control inflation.
    In short if a society is not health it can not prosper.

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