U.S. Senator Bob Casey (D-PA), Chairman of the U.S. Senate Special Committee on Aging, sent a letter this week to Center for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure seeking information about the oversight of Medicaid managed care organizations (MCOs). In the letter, Chairman Casey raises concerns about health insurance companies routinely denying coverage of medically necessary care for people enrolled in Medicaid MCOs—an issue examined in recent watchdog reports that Casey previously requested. The letter seeks information about the steps CMS and states are taking are being taken to protect Medicaid enrollees and prevent MCOs from putting their bottom line ahead of the interests of patients seeking care.
“It is abundantly clear that MCO denials of coverage can negatively affect patients,” wrote Chairman Casey. “The Office of the Inspector General’s findings—coupled with the everyday experiences of my constituents in Pennsylvania—demonstrate more must be done so that older adults, people with disabilities, and children, all receive the care they need and deserve.”
State Medicaid programs pay health insurance companies a fixed annual fee, known as capitated payments, to operate MCOs that provide health insurance to Medicaid enrollees. MCOs have grown to become the dominant delivery system for health care coverage within the Medicaid program. More than 67 million people received full or partial Medicaid coverage from MCOs in 2020, accounting for 84 percent of enrollees.
In 2019, Chairman Casey sent a letter to the Office the Inspector General (OIG) calling for an investigation of whether patients enrolled in MCOs can successfully access the services to which they are entitled. Subsequently, OIG released a series of oversight reports issuing recommendations to MCOs, states, and CMS to address issues including repeated instances of improper service denials and failures to provide enrollees with information needed to file appeals. Today’s letter from Chairman Casey seeks additional information and data from CMS and urges the agency to implement OIG’s recommendations to ensure patients are not being denied care.
Senator Casey has a long record of fighting to protect and expand Medicaid. Earlier this month, Senator Casey introduced the Medicaid for Every Child Act, which would automatically enroll every child in Medicaid from birth until age 18. The bill would guarantee coverage for over 2.6 million children in Pennsylvania, including over 645,000 children in rural counties where health care has historically been more difficult to access.
Read the full letter here.
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