Office of Program Policy Analysis and Government Accountability
Office of Program Policy Analysis and Government Accountability

Medicaid Reform: Reform Provider Network Requirements Same as Traditional Medicaid; Improvements Needed to Ensure Beneficiaries Have Access to Specialty Providers

Report 08-64, November 2008




Report Summary

  • While access to providers is expected to improve under Medicaid Reform, the Agency for Health Care Administration uses the same contract requirements to assure that both Medicaid Reform and non-Reform managed care plans include an adequate number and array of providers with offices located within reasonable travel distances. For the most part, the agency also monitors provider network adequacy the same way for both Reform and non-Reform plans. To better ensure that Reform provider networks meet beneficiary needs, the agency should develop additional Reform contract requirements as well as improve its oversight of provider networks.
  • Information available to Reform beneficiaries about providers participating in Reform plans is not always accurate. As a result, some beneficiaries have experienced difficulty selecting a plan that meets their needs and ensures that they can make appointments to see specialty providers. In addition, there is conflicting evidence to support whether access to specialty providers has improved or not in the Reform counties.


Related Reports
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    Report 09-29 June 2009
  2. Medicaid Reform: Oversight to Ensure Beneficiaries Receive Needed Prescription Drugs Can Be Improved; Information Difficult for Beneficiaries to Locate and Compare
    Report 08-55 September 2008
  3. Medicaid Reform: Risk-Adjusted Rates Used to Pay Medicaid Reform Health Plans Could Be Used to Pay All Medicaid Capitated Plans
    Report 08-54 September 2008
  4. Medicaid Reform: Choice Counseling Goal Met, But Some Beneficiaries Experience Difficulties Selecting a Health Plan That Best Meets Their Needs
    Report 08-46 July 2008
Copies of this report in print or alternate accessible format may be obtained by email OPPAGA@oppaga.fl.gov, telephone (850) 488-0021, or mail 111 W. Madison St., Room 312 Tallahassee, FL 32399-1475.
Copies of this report in print or alternate accessible format may be obtained by email OPPAGA@oppaga.fl.gov, telephone (850) 488-0021, or mail 111 W. Madison St., Room 312 Tallahassee, FL 32399-1475.
social services, health, human services; Medicaid Reform, provider networks, provider directories, beneficiary choice, access to care, provider availability, Medicaid, managed care, Health Maintenance Organization, HMO, Provider Service Network, PSN, fee-for-service, FFS, waiver, PDL, prescription drug list, prescription drug, prior authorization