Federal Regulators Fail to Provide Effective Oversight of Medicaid Managed Care Programs

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Following news reports that Medicaid managed care contractors are not properly delivering care to patients, Sen. Casey from Pennsylvania has written to the Centers for Medicare & Medicaid Services (CMS), urging the agency to investigate the matter. News reports have highlighted issues in California, Iowa, and Texas, where managed care companies refused to provide medically necessary care to beneficiaries. The most shocking case comes from 2018, when the Dallas Morning News investigated a situation in Texas where the state’s managed care entity, Centene, refused to provide medically necessary nursing care to a foster child with special needs. Due to this care denial, the child suffered a catastrophic injury that caused him to descend into a persistent vegetative state, fully dependent on life support for survival. Texas officials determined that Centene’s actions violated state and federal law and that the company is responsible for causing the foster child’s current condition, but enforcement action was never taken against the company.

Sen. Casey has questioned Centene executives about this preventable tragedy, but the company continues to deny that they provided inadequate care. Centene’s refusal to take responsibility for denying medically necessary care has galvanized Sen. Casey to push CMS to investigate these issues and provide greater oversight of Medicaid managed care companies. Unfortunately, CMS has not taken any action to address these types of care denials by Medicaid managed care companies.

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