Senate Special Committee on Aging Seeks Answers on Oversight of Medicaid Managed Care Organizations

Home Care Association of America

Senate Special Committee on Aging Chairman Bob Casey (D-PA) sent a letter to CMS seeking information and raising concerns about the oversight of Medicaid managed care organizations (MCOs). Citing a recent report from the Office of Inspector General, Sen. Casey expressed concern over health insurance companies denying medically necessary care for individuals enrolled in Medicaid MCOs.

​These MCOs receive fixed annual fees, known as capitated payments, from state Medicaid programs to provide health insurance to Medicaid enrollees. However, the letter highlighted the OIG's warning that such payment models can create incentives for insurance companies to deny services to increase profits. Sen. Casey's letter requests information on the steps being taken by CMS and states to protect Medicaid enrollees and ensure that MCOs prioritize patient care over profit margins.