Question

Case 6: Managed Care

BACKGROUND

Examining access to care takes on heightened importance as enrollment grows in Medicaid managed care programs. Under the Patient Protection and Affordable Care Act, states can opt to expand Medicaid eligibility, and even states that have not expanded eligibility have seen increases in enrollment. Most states provide some of their Medicaid services—if not all of them—through managed care. The Office of Inspector General received a congressional request to evaluate the adequacy of access to care for enrollees in managed care. This report determines the extent to which providers offer appointments to enrollees and the timeliness of these appointments. A companion report issued earlier this year, State Standards for Access To Care in Medicaid Managed Care, OEI-02-11-00320, found that state standards for access to care vary, and that they are often not specific to certain provider types or to areas of the state. Additionally, states have different strategies to assess compliance with access standards.

HOW WE DID THIS STUDY

We based this study on an assessment of availability of Medicaid managed care providers. The assessment included calls to a stratified random sample of 1,800 primary care providers and specialists to assess availability and timeliness of appointments for enrollees.

WHAT WE FOUND

We 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 8 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.

QUESTION:

1. As a healthcare administrator what recommendations would you implement from the findings in this plan with regards to access for the Medicaid managed care enrollee?

Answer 1

Medicaid managed care organization as a health care administrator role for providing access to care for their enrollees..They also take initiatives to improve the quality of care delivery..Health care administrator role to meet access and quality standards..Their responsible to pay a fixed per capita fee or capitation payment to private health insurance plans they provide services to enrollee..They improve the coordination of care and deliver medicaid program health care services to their beneficiaries by reducing the costs and better managed services by reducing patients waiting time to receive the health services..