Medicaid MCOs Skimping on Care?
Medicaid MCOs may be skimping on care, according to a recent Kaiser Health News report.
According to Kaiser, for-profit companies that sub-contract with Medicaid managed care organizations to review requests for services often deny care to Medicaid patients to save money for the MCOs that employ them and to benefit themselves financially.
The Kaiser article presents examples of companies that have been identified engaging in such practices, explains how they go about their work, and outlines the dangers to Medicaid recipients posed by such practices.
Because they serve so many more Medicaid patients than the typical hospital, Pennsylvania safety-net hospitals, their patients, and the communities they serve can be greatly affected by such practices.
Learn more in the Kaiser Health News article “Coverage Denied: Medicaid Patients Suffer As Layers Of Private Companies Profit.”
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An early November bulletin from CMS, however, clarifies that this approach is still permissible, which is good news for Pennsylvania safety-net hospitals and SNAP members hoping to benefit from the state’s hospital assessment.
Pennsylvania Governor Tom Wolf has vetoed a bill that included a requirement that certain Medicaid recipients either work or search for work.
Among the issues addressed in the letter are how the House-passed proposal would detract from the role of Medicaid in fighting the state’s opioid crisis; the proposed reduction in tax credits to help purchase health insurance; the challenge posed by a per capita approach to Medicaid financing; the potential loss of health care jobs; the likelihood of large numbers of Pennsylvanians losing their health insurance and state Medicaid costs rising significantly; and the erosion of consumer protections.
The Safety-Net Association of Pennsylvania has prepared a detailed review of those provisions. Officials of safety-net hospitals who would like to receive a copy of this memo may request one by using the “contact us” link on the upper right-hand corner of this screen.