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Advocates Urge More Government Oversight Of Medicaid Managed Care

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Advocates say access problems remain and Florida’s oversight is inadequate. “The state is supposed to be overseeing all of this. They haven’t done a good job of that,” said Laura Goodhue, executive director of Florida CHAIN, a statewide health care advocacy group.

Experts caution that even in states that devote lots of resources to oversight, many of the quality standards they use are aimed at figuring out whether services were provided, not the effect on patients’ health – what they call “outcome.”

“Even if there’s an intent to aggressively monitor, you have to figure out whether and how they’re doing it. And measuring quality is really, really tough,” said Michael Sparer, a Columbia University professor of health policy. “We can say immunization rates have gone up or waiting times are down…But measuring whether outcomes have changed substantively is very elusive and difficult to get at.”

In a few states, legislators have tried to beef up oversight.

In Kansas, which in January moved nearly all of its 380,000 Medicaid members into plans run by three commercial plans, the legislature decided to do its own oversight. It unanimously passed a bill in March that would establish a joint legislative committee to monitor the state’s Medicaid managed care program. The governor signed it in April.

“We need to make sure they’re adhering to contractual arrangements, that they’re providing the services they committed to provide, that our Medicaid clients have access to services and are actually getting them,” said Kansas State Sen. Laura Kelly, a Topeka Democrat.

In Kansas and several other states, consumer advocates worry that officials are rushing too quickly to move vulnerable elderly, mentally ill and physically disabled people into Medicaid managed care for long-term services, such as home health and personal care. They say states don’t have systems in place to properly monitor quality of care or the plans’ performance. A 2012 study by Truven Health Analytics estimated that the number of states with these programs will grow from 16 to 26 by 2014.

Wed, Jul 03 2013

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