State standards for access to care for those enrolled in Medicaid managed care programs varies greatly, according to a new report from the Office of the Inspector General (OIG).
The OIG interviewed and collected documents from Medicaid officials in the 33 states with full Medicaid managed care, looking at state standards from January 1, 2008 through January 1, 2013.
Two main findings:
Standards depend on the state
Under Medicaid regulations, states must establish access standards. These may include standards that spell out the amount of time enrollees should have to travel to see a doctor, ensure appointments are within a certain timeframe and require a limited number of providers based on the number of enrollees.
Based on these standards, the OIG discovered certain discrepancies among states. While all but one of the 33 states established provider-distance standards, only 20 focused on the provider-to-enrollee ratio. While the aforementioned standards are the ones most common, all but one state had a least two of these types.
Violations of access standards spotty
During the five-year timeframe, only 11 of the 33 states noted a violation of their access standards, the report found. Identifying violations allows states to improve the access to care for enrollees.
While New York was a main player for Medicaid enrollees this past enrollment season, the state identified 63 violations from 2008 to 2013. The most common violations found related to issues with appointment availability and provider-to-enrollee ratio, the report found.
The OIG concludes the report with recommendations on how to decrease the variance among states. It calls for the Centers for Medicare & Medicaid to work directly with states to develop standards that best suit their enrollees' needs.
What's more, CMS should work better with states to identify and address violations, which will ultimately improve access to care.
- here's the report (.pdf)