HHS Report: Access to Care: Provider Availability in Medicaid Managed Care

The Office of Inspector General (OIG) received a congressional request to evaluate the adequacy of access to care for enrollees in Medicaid managed care. This report determines the extent to which providers offer appointments to enrollees and the timeliness of these appointments. The report released in December 2014, found that slightly more than half of providers could not offer appointments to enrollees. Notably, 35 percent could not be found at the location listed by the plan, and another 8 percent were at the location but said that they were not participating in the plan.An additional percent were not accepting new patients. Among the providers who offered appointments, the median wait time was 2 weeks. However, over a quarter had wait times of more than 1 month, and 10 percent had wait times longer than 2 months. Finally, primary care providers were less likely to offer an appointment than specialists; however, specialists tended to have longer wait times.Together, these findings—along with those from a companion report—call for CMS to work with States to improve the oversight of managed care plans.

HHS recommends that CMS work with States to:

(1) assess the number of providers offering appointments and improve the accuracy of plan information,

(2) ensure that plans’ networks are adequate and meet the needs of their Medicaid managed care enrollees, and

(3) ensure that plans are complying with existing State standards and assess whether additional standards are needed.

CMS concurred with all three of HHS’ recommendations.

 

The full report is available here: Access to Care-Provider Availability in Medicaid Managed Care.