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April 24, 2024
Secret Shopper Surveys: A Powerful Tool for Directly Testing Medicaid Managed Care Enrollees’ Access to Care
Michelle Yiu and David Machledt Delivery System Reform, Uncategorized
For many Americans, accessing health care can be deeply frustrating, stressful, and confusing. While individuals may face various problems when navigating insurance and the health care system at-large, the initial task of scheduling an appointment with an in-network provider should arguably be the most straightforward. However, according to a…
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January 5, 2023
Medicaid Managed Care Accountability: How States Use Sanctions
Daniel Young california, Delivery System Reform, Uncategorized
In the Medicaid program, comprehensive managed care is the predominant mode for delivering services. Approximately, seventy-two percent of beneficiaries receive services through managed care, covering 57 million people, in forty-one states. The contracts between managed care organizations (MCOs) and state Medicaid agencies spell out the services and benefits MCOs…
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December 20, 2021
California‘s Delivery of Prescription Drugs to Medi-Cal Recipients Undergoes Major Change on January 1st
Abigail Coursolle california, Delivery System Reform, Health Equity
California Governor Gavin Newsom’s first act after being sworn in as Governor in 2019 was to take aim at reducing the cost of prescription drugs for the state and improving Californian’s access to prescription medication. One component of the Governor’s plan was the change payment for and delivery of…
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June 30, 2021
A Promise Unfulfilled: Automated Medicaid Eligibility Decisions
Sarah Grusin Automated Decision-Making, Delivery System Reform, Disability, Eligibility & Enrollment, Medicaid Awareness Month, Uncategorized
States have spent millions of dollars building Medicaid eligibility systems that promise automated, real-time, and accurate eligibility decisions. This is a worthy goal because unnecessary paperwork burdens cause eligible individuals to lose coverage for failure to complete forms. The promise of automated eligibility determinations, however, is often not realized…
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June 14, 2021
Preventing Harm from Automated Decision-Making Systems in Medicaid
Elizabeth Edwards Automated Decision-Making, Delivery System Reform, Disability, Eligibility & Enrollment, Uncategorized
Algorithms and other automated decision-making systems (ADS) are omnipresent features of today’s Medicaid systems. While there are some advantages to automated decisions, the idea that such decisions are free from bias or error is false. Humans are behind the design, programming, and ultimate decisions on what to do with…
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April 14, 2020
Medicaid Due Process and COVID-19 – Part I
Sarah Somers Coronavirus, Delivery System Reform, Uncategorized
The individual’s rights to receive notice of and challenge a decision about coverage is the foundation of the Medicaid benefit. But, even in the best of times, state Medicaid agencies and managed care plans don’t always observe these rights. Crisis situations make it more likely that rights will be…
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Secret Shopper Surveys: A Powerful Tool for Directly Testing Medicaid Managed Care Enrollees’ Access to Care

Medicaid Managed Care Accountability: How States Use Sanctions

California‘s Delivery of Prescription Drugs to Medi-Cal Recipients Undergoes Major Change on January 1st

A Promise Unfulfilled: Automated Medicaid Eligibility Decisions

Preventing Harm from Automated Decision-Making Systems in Medicaid

Medicaid Due Process and COVID-19 – Part I