“Medicaid managed care denies prior authorizations at higher rate than Medicare Advantage: analysis,” by Kimberly Marselas, McKnights LTC News
Quote:
“Overall, insurers participating in federal programs denied at least 1 out of every 8 standard requests for prior authorization, including 12% of Medicare Advantage requests and 14% of Medicaid managed care requests. The rate hit 18% in the Affordable Care Act Marketplaces. The new data demonstrates the added barriers providers face in caring for patients on Medicaid, who account for more than 60% of patient stays nationally. Some 42 states now have some form of managed care in their Medicaid programs, and KFF reported last year that those payments accounted for 29% of all nursing home Medicaid spending.”
LTC Comment, Stephen A. Moses, President, Center for Long-Term Care Reform:
State Medicaid programs were happy to turn over the responsibility for funding and managing their LTC programs to private insurers. The unintended consequences for patients and providers are showing up more and more.