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Senate Special Committee on Aging Seeks Answers on Oversight of Medicaid Managed Care Organizations

10/11/2023

2 Comments

 
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​Senate Special Committee on Aging Chairman Bob Casey (D-PA) sent a letter to CMS seeking information and raising concerns about the oversight of Medicaid managed care organizations (MCOs). Citing a recent report from the Office of Inspector General, Sen. Casey expressed concern over health insurance companies denying medically necessary care for individuals enrolled in Medicaid MCOs.
​These MCOs receive fixed annual fees, known as capitated payments, from state Medicaid programs to provide health insurance to Medicaid enrollees. However, the letter highlighted the OIG's warning that such payment models can create incentives for insurance companies to deny services to increase profits. Sen. Casey's letter requests information on the steps being taken by CMS and states to protect Medicaid enrollees and ensure that MCOs prioritize patient care over profit margins.
2 Comments
Beth Bigham link
10/11/2023 11:17:22 am

In Indiana, we're moving to a MCO model. As a provider, we still dont' have a lot of questions even answered on 'how will this all work' - yet we're being asked to sign contracts. Ahh... wait a minute! Our governor and top insurance companies picked this. I'm NOT looking forward to this. More, later if anyone wants to talk to me abour what I'm seeing as I go through this and sign our company up, as a provider.

Reply
Health Insurance MA link
11/8/2023 12:54:13 am

I'm glad to see Senator Casey's commitment to addressing the concerns surrounding Medicaid managed care organizations. Ensuring that individuals enrolled in Medicaid MCOs receive the necessary care is crucial. The focus on patient care over profits is essential, and I hope that CMS and states take the necessary steps to protect the well-being of Medicaid enrollees. This is a significant step towards improving the healthcare system.

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  • Membership Resources
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