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Health Insurance & Affordable Care Act

Advocates Urge More Government Oversight Of Medicaid Managed Care

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Matt Salo, executive director of the National Association of Medicaid Directors, said states may oversee quality and access differently, but that he’s “not aware of anyone doing it badly.”

Salo pointed out that in traditional Medicaid, with states focused on paying doctors and hospitals for each service they provide, there is little monitoring and oversight, other than for financial fraud and abuse.

“The irony about quality is that consumer advocates say we’re not sure there’s a proper focus on quality. But where are the quality measures for fee-for-service Medicaid?” he said.

Some state Medicaid offices have taken a hit in recent years because of budget cuts – Washington state’s program lost more than 200 positions since 2009. And oversight isn’t always a priority, says Carolyn Ingram, a former New Mexico Medicaid director who is senior vice president of the Center for Health Care Strategies, a nonprofit health policy center.

Ingram said Medicaid directors who are getting pressured by governors and legislatures to expand managed care often end up focusing on “bright and shiny” new initiatives. “Oversight of our managed care plans is less bright and shiny,” she said. “The day-to-day monitoring of managed care plans goes kind of on the back burner. That’s where you put your newer staff, your green staff.”

Florida’s experience with managed care underscores the importance of close monitoring. After the state launched a pilot program in 2006, doctors were unhappy about delayed payments and administrative obstacles, patients complained about being denied access to services and data on the quality of care was lacking. Several insurers dropped out because they couldn’t make enough money.

State officials say those problems have been fixed. In 2011, the federal government approved an extension of the pilot and in June agreed to allow Florida to expand it statewide.

But Georgetown University’s Health Policy Institute has been critical of Florida’s pilot program.  “Little data is available to assess whether access to care has improved or worsened,” it reported in 2011, noting there is no “clear evidence” the program is saving money and if it is, “whether the savings came at the expense of needed care.”

Wed, Jul 03 2013

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