How well are Apple Health Managed Care Organizations (MCOs) doing their job? NoHLA is working to uncover the answer. This is a critical issue in addressing access to care, as 2.3 million Washington state residents now get their health coverage through Washington Apple Health (Medicaid, CHIP, and related state programs) and the state contracts with MCOs to provide care to nearly 2 million of them. As MCOs, most of which are for-profit companies, are responsible for delivering care to a significant proportion of Washingtonians, they need to be publicly accountable for the care they provide. NoHLA is working to improve their oversight and accountability. We recently provided comments on two sets of proposed federal regulations: one to strengthen MCO Access, Finance, and Quality, and another to improve beneficiary and advocate participation in Medicaid Advisory Committees. 

NoHLA’s comments included support for:

• hearing from enrollees themselves about their MCO experiences;
• requiring secret shopper surveys to assess whether MCO provider directories are current; and
• reducing wait times for routine appointments.

MCOs started providing care in Washington state in 1985 with the goal of managing cost, utilization, and quality for the Medicaid population, but it is unclear whether the five MCOs that operate here have made progress toward those goals. Based on our more than 20 years of experience with MCOs, we have observed that enrollees continue to face serious problems obtaining the services they need in a timely manner. A recent external quality report, for example, aggregates the MCOs coverage and authorization of services at 53% and four of the five MCOs did not meet all elements for the Quality Assessment and Performance Improvement Program (QAPI), and Coverage and Authorization. 

We are always interested in hearing about experiences with Medicaid MCOs–please share them with us at nohla@nohla.org.