Medicaid Advocates Decry Coverage Denials for Poor in Report (1)

Medicaid advocates are sounding the alarm over systemic oversight failures and misaligned incentives that allow Medicaid managed care companies to restrict patient access to health-care services.

The Department of Health and Human Services Office of Inspector General found that 37 states it surveyed had systemic problems with their prior authorization processes, leading to inappropriate denials of coverage. These problems included not informing Medicaid patients of their right to appeal a denial, allowing insufficiently trained staff to make prior authorization decisions, and writing notices in ambiguous, often hard-to-understand language that missed or concealed important information such as the reason for a ...