Department of Health
Assessing Medicaid Managed Care Provider Networks (Follow-Up Review) In our prior audit report 97-S-59, we examined the process used by the Department of Health for determining the maximum number of Medicaid recipients that can be served by a managed care organization without compromising the quality of the services provided. We found that, while the Department routinely assessed the capacity of the managed care organizations serving Medicaid recipients, these assessments did not consider the number of non-Medicaid patients who were enrolled in each organization, and did not fully consider whether a managed care organization's primary care providers were easily accessible to their patients. If these factors are not appropriately taken into account, the quality of the care provided to some Medicaid recipients might be jeopardized by excessive patient caseloads and difficult-to-access health care providers. In our follow up review, we found that the Department had taken steps to address the weaknesses identified in our prior report.
For a complete copy of Report 2001-F-6 click here.