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Medicaid Managed Care Organization Denials

The State Medicaid agency and the Federal Government are responsible for financial risk for the costs of Medicaid services. Managed care organizations (MCOs) contract with State Medicaid agencies to ensure that beneficiaries receive covered Medicaid services. The contractual arrangement shifts financial risk for the costs of Medicaid services from the State Medicaid agency and the Federal Government to the MCO, which can create an incentive to deny beneficiaries' access to covered services. Our review will determine whether Medicaid MCOs complied with Federal requirements when denying access to requested medical and dental services and drug prescriptions that required prior authorization.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
April 2019 Centers for Medicare & Medicaid Services Medicaid Managed Care Organization Denials Office of Audit Services W-00-19-31535 2020