States Offer Poor Access for Medicaid Managed Care Networks, OIG Report Finds

As Medicaid enrollment grows under expansion of the program due to the Affordable Care Act, there are not enough providers to serve the increased amounts of enrollees, according to a new report from the Office of the Inspector General (OIG) that measured the availability of specific providers in Medicaid managed care networks.

Half of providers in the sample of 1800 primary care providers and specialists assessed could not offer appointments to Medicaid enrollees. More than a third (35%) could not even be found at the location listed by the plan.

“When providers listed as participating in a plan cannot offer appointments, it may create a significant obstacle for an enrollee seeking care,” according to the report. “Moreover, it raises questions about the adequacy of provider networks—it suggests that the actual size of provider networks may be considerably smaller than what is presented by Medicaid managed care plans.”

Another 8% were at the location listed, they said they were not participating in the plan. In some cases they had participated in the past, but in others the providers had never participated in the Medicaid managed care plan, according to the report. Lastly, another 8% said they were not accepting new patients.

Of those providers who were offering appointments to Medicaid patients, the wait time was roughly 2 weeks, although 10% had wait times longer than 2 months. Although specialists tended to have longer wait times, primary care providers were less likely to offer appointments, according to the findings.

Based on the report, OIG recommends that CMS work with states in order to: assess the number of network providers who can offer timely appointments; improve the accuracy of plan information; ensure plans’ networks are adequate and meet the needs of enrollees; and ensure plans are complying with existing state standards and assess whether additional standards are needed.

“Our findings demonstrate significant vulnerabilities in provider availability, which is a key indicator for access to care,” the report concludes. “These findings also raise serious questions about the abilities of plans, states, and CMS to ensure that access-to-care standards are met.”