Medicaid Advisers Back New Protections for Patients Denied Care

Congress’s Medicaid advisers on Friday endorsed a series of steps policymakers could take to overhaul the appeal process for beneficiaries denied access to care by a managed care organization.

The proposals from the Medicaid and Chip Payment and Access Commission include allowing impartial third-party doctors to review claims in the event a claims appeal is denied by a managed care organization (MCO).

The move to protect Medicaid beneficiaries’ access to coverage comes after a July 2023 report from the Department of Health and Human Services Office of Inspector General found many MCOs had high rates of prior authorization denials, ...