With more states delegating their programs of Medicaid managed long-term services and supports to managed care entities, state Medicaid programs and the federal government are not adequately overseeing the work of those managed care plans.
As a result, they sometimes fail to notice quality and access problems for beneficiaries, according to the U.S. Government Accountability Office.
When states delegate to managed care plans decisions about the amount and types of services that adults and children with physical, cognitive, and mental disabilities will receive, federal guidelines require states to monitor those decisions for appropriateness. In too many cases, the GAO has concluded, states are not doing this job well. To address this shortcoming, the GAO recommends that the Centers for Medicare & Medicaid Services develop a national strategy for overseeing MLTSS and “assess the nature and prevalence of MLTSS quality and access problems across the states.” CMS rejected these recommendations.
Learn more about the challenges inherent in managed care plans administering Medicaid MLTSS in the GAO report Medicaid Long-Term Services and Supports: Access and Quality Problems in Managed Care Demand Improved Oversight.