OBJECTIVE
Medicaid managed care organizations (MCOs) use a process referred to as “prior authorization” to make millions of decisions each year about whether to approve requests for coverage of specific services according to medical necessity and relevant coverage requirements. In capitated payment models like Medicaid managed care, a central concern about the use of prior authorization processes is the potential incentive for MCOs to deny access to medically necessary health care services in order to lower their costs. This study will examine characteristics of prior authorization denials, including the types of services and enrollees most impacted by denials and the extent to which MCOs varied in their denial patterns.
TIMELINE
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July 15, 2026Announced
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