The industry group representing Medicaid managed care plans is applauding a new report by federal investigators that found that the Centers for Medicare and Medicaid Services has been approving contracts that don't meet federal requirements.
While some federal officials highlighted the importance of making sure Medicaid gets value for its money, the private plans say they're the ones who have been getting shortchanged. The new report by the Government Accountability Office, Medicaid Health Plans of America says, confirms those suspicions.
"Federal law mandates that states provide Medicaid health plans with ... payments that are actuarially sound, a requirement which helps these health plans obtain adequate reimbursement and provide needed care," MHPA President and CEO Thomas Johnson said in a statement. "States, however, use a variety of rate-setting methods that are often influenced by state budgetary factors and not by the cost of health care expenditures. While CMS is required to certify that states' rates are actuarially sound, Medicaid health plans have long felt that enforcement of this requirement through the CMS regional offices has been inconsistent. The findings of this study confirm the experiences of our member health plans."