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Medicaid Reform: Reform Provider Network Requirements Same as Traditional Medicaid; Improvements Needed to Ensure Beneficiaries Have Access to Specialty Providers, Report No. 08-64, November 2008
 
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  • 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.

Which Government Program Summaries contain related information?

Medicaid Health Care Services
Agency for Health Care Administration
Health Quality Assurance

What other OPPAGA-related materials are available?

  • Report No. 09-29 Medicaid Reform: Legislature Should Delay Expansion Until More Information Is Available to Evaluate Success,published in June 2009.
  • Report No. 08-55 Medicaid Reform: Oversight to Ensure Beneficiaries Receive Needed Prescription Drugs Can Be Improved; Information Difficult for Beneficiaries to Locate and Compare, published in September 2008.
  • Report No. 08-54 Medicaid Reform: Risk-Adjusted Rates Used to Pay Medicaid Reform Health Plans Could Be Used to Pay All Medicaid Capitated Plans, published in September 2008.
  • Report No. 08-46 Medicaid Reform: Choice Counseling Goal Met, But Some Beneficiaries Experience Difficulties Selecting a Health Plan That Best Meets Their Needs, published in July 2008.
  • Report No. 08-45 Medicaid Reform: Beneficiaries Earn Enhanced Benefits Credits But Spend Only a Small Proportion, published in July 2008.
  • Report No. 08-40 Medicaid Reform: Two-Thirds of the Initial Pilot Counties’ Beneficiaries Are Enrolled in Reform Plans, published in June 2008.
  • Report No. 08-38 Medicaid Reform: More Managed Care Options Available; Differences Limited by Federal and State Requirements, published in June 2008.
  • Report No. 08-37 Medicaid Reform: Few Beneficiaries Have Participated in the Opt-Out Program, published in June 2008.

Copies of this report in print or alternate accessible format may be obtained by telephone (850/488-0021), by FAX (850/487-9213), in person, or by mail (OPPAGA Report Production, Claude Pepper Building, Room 312, 111 W. Madison St., Tallahassee, FL 32399-1475).
e-mail address: oppaga@oppaga.fl.gov


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