Are Managed Care Providers Wrongly Denying Services To People With Disabilities?
As more states turn to managed care to administer Medicaid, federal investigators are set to examine whether these companies are offering people with disabilities the care they’re entitled.
The U.S. Department of Health and Human Services’ Office of Inspector General said it will investigate whether managed care organizations are wrongly denying services.
Many states have turned to private insurers to handle their Medicaid services, including those for people with developmental disabilities. Under the arrangements, states pay insurers a set amount of money to administer benefits.
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“The contractual arrangement shifts financial risk for the costs of Medicaid services from the state Medicaid agency and the federal government to the MCO, which can create an incentive to deny beneficiaries’ access to covered services. Our review will determine whether Medicaid MCOs complied with federal requirements when denying access to requested medical and dental services and drug prescriptions that required prior authorization,” the HHS inspector general said in announcing the plan to investigate.
The move comes at the request of Sen. Bob Casey, D-Pa. In a letter to HHS Inspector General Daniel R. Levinson last month, Casey cited reports from the Dallas Morning News and the Des Moines Register suggesting that some managed care companies have wrongly denied needed care.
“It is the duty of MCOs, as a steward of taxpayer dollars, to spend Medicaid funds responsibly in pursuit of the health of our families,” Casey wrote. “What the Dallas Morning News and Des Moines Register uncovered, however, were actions taken by MCOs focused squarely on delivering profits to wealthy shareholders at the expense of those most in need of medical care.”
Specifically, Casey wants the inspector general to address whether people with disabilities and other groups that weren’t traditionally covered by managed care are being adequately served by these companies. And, the senator said the investigation should examine if people with disabilities are being denied access to care at higher rates than other Medicaid beneficiaries.
What’s more, Casey asked the inspector general to look into whether the Centers for Medicare and Medicaid Services is adequately providing oversight to ensure that Medicaid beneficiaries are getting the services they need.
The HHS Office of Inspector General said a report detailing its findings is expected sometime next year.
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