Variation in network adequacy standards in Medicaid managed care

Study Design: Document analysis of Medicaid provider network reports, managed care plan contracts, access monitoring review plans, Medicaid services manuals, quality strategy reviews, and state statutes and regulations. Nonetheless, it is likely that this policy will pertain to most Medicaid beneficiaries, at least 70% of whom are enrolled under managed care plans.7 Although some reports have relied on case studies of up to 14 states,8,9 there is no comprehensive assessment of the network adequacy standards currently used by state Medicaid programs. DATA AND METHODS From April to December 2020, we conducted a search for published network adequacy standards in states with full or partial Medicaid services provided through managed care organizations. Medicaid provider network reports, timely access standards, managed care plan contracts, access monitoring review plans, Medicaid services manuals, quality strategy reviews, and state statutes and regulations.