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Access Standards Vary Widely in Medicaid Managed Care

The U.S. Department of Health and Human Services Office of the Inspector General (OIG) has determined that access to care standards for Medicaid managed care enrollees vary widely by state. In its recent report, OIG also found that states often lack specifications regarding location of providers or provider specialty and that the Centers for Medicare & Medicaid Services (CMS) currently provides limited oversight of state access standards. CMS has concurred with the following recommendations, put forth by OIG:

  • Strengthen oversight and ensure states develop standards for key providers.
  • Strengthen oversight of states’ methods to assess plan compliance.
  • Improve states’ efforts to identify and address access standard violations.
  • Provide technical assistance and share effective practices.

Please contact Xiaoyi Huang, JD, director of policy, at xhuang@essentialhospitals.org or 202.585.0127, with questions.

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About the Author

Matt Buechner is the policy and advocacy associate for America's Essential Hospitals.

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