Medicaid Managed Care
Expert articles and analysis related to medicaid managed care.
AI Summary — Last 7 Days
Medicaid managed care scrutiny intensified around access and program integrity: an HHS OIG review flagged maternal-health “ghost networks” in Medicaid managed care, raising risk for states, MCOs, and VBC providers that network adequacy and directory accuracy will become more central to quality oversight and contract accountability. At the same time, RAND’s state-level analysis of Medicaid provisions in the One Big Beautiful Bill Act points to uneven fiscal and coverage impacts across states, while DOJ’s suit over New York’s $10 billion home-care program reinforces the Trump administration’s focus on fraud controls in high-cost Medicaid services—pressuring Medicaid MCOs and risk-bearing providers to strengthen encounter-data validation, referral access, and home- and community-based services oversight. These developments intersect with CMS’ interoperability and prior authorization rulemaking, where hospital and purchaser groups are pushing for administrative simplification that could reshape utilization management workflows across Medicaid managed care and other federal programs ([OIG maternal “ghost networks” coverage](https://news.google.com/rss/articles/CBMixAFBVV95cUxQM2VwQ3IwcGt1bHJla1IxYVNjbDNGRGRFa05GS0FCMHBidzZrNllaNmwtVFlRaXNFMzkwNzUtRmM0V0x5RXdJcnM5SWtEcVpkVS13XzFydTF3WWtiTXlqcks1Wk80NXpzSHJTTE
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