Series: Medicaid Managed Care Organizations' Denials

OBJECTIVE

The State Medicaid agency and the Federal Government are responsible for the financial risk for the costs of Medicaid services. State Medicaid agencies contract with managed care organizations (MCOs) to ensure that beneficiaries receive covered Medicaid services. The contractual arrangement shifts the financial risk from the State Medicaid agency and the Federal Government to MCOs, which can create an incentive for MCOs to deny beneficiaries' access to covered services. Our audits will determine whether Medicaid MCOs complied with Federal requirements when denying access to requested medical and dental services, behavioral health services, and associated drug prescriptions that required prior authorization.

There are 3 projects in this series.

Project titles will remain unpublished until projects are complete and reports are posted.

ACTIVE PROJECTS IN THIS SERIES (3)

TIMELINE

• February 8, 2024
  Series Number W-00-24-31535 Assigned
• February 8, 2024
  Project Announced

  Project A-06-24-02000

• February 20, 2024
  Project Announced

  Project A-03-24-00204

• August 19, 2024
  Project Announced

  Project A-09-24-02007

• Today
  3 Audits In-Progress
• Est FY2026
  Estimated Fiscal Year for Series Completion

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