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Commonwealth Fund (Publications)

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Commonwealth Fund Reviews State Options for Addressing Medicaid MCO Performance Issues

The Commonwealth Fund published guidance on how state Medicaid agencies can address underperforming managed care plans through contractual tools and staff oversight strategies. The analysis covers corrective action plans, financial penalties, contract suspension, and systematic performance monitoring approaches states can deploy when plans fail to meet quality, access, or administrative standards. The guidance emphasizes strategic prioritization of enforcement resources and graduated remedies. State Medicaid agencies managing MCO contracts gain a framework for structuring performance oversight and escalating interventions when plans fall short of contractual obligations.

commonwealthfund.org

Federal Policy·36d ago

H.R. 1 Medicaid Provisions Expected to Increase State Payment Error Rates

H.R. 1 introduces Medicaid work requirements and other eligibility changes that are expected to complicate state eligibility determinations and increase payment error rates. The legislation adds new verification requirements and eligibility criteria that states must administer, creating additional documentation burdens and potential error points in the Payment Error Rate Measurement (PERM) process. These changes take effect upon enactment, with states required to implement new systems and processes to manage the added complexity. States face heightened risk of federal scrutiny and potential financial penalties as error rates climb due to the more complex eligibility landscape.

commonwealthfund.org