Medicaid MCOs Denied at Least 1 in 8 Prior Authorization Requests in 2025
Analysis of 2025 prior authorization data shows Medicaid managed care organizations denied at least 12.5% of standard prior authorization requests, with denial rates varying significantly across insurers. The data, which also covers Medicare Advantage and ACA Marketplace plans, reveals inconsistencies in insurer practices but includes methodological limitations that complicate interpretation. The findings come as state Medicaid agencies and CMS face pressure to improve prior authorization transparency and oversight of MCO utilization management practices.
State Medicaid agencies and MCOs face growing scrutiny over prior authorization denial rates, with potential implications for contract oversight, access to care metrics, and network adequacy compliance.
Managed Care
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