Medicaid MCOs Often Deny Prior Authorization Requests, OIG Report Says

Medicaid managed care organizations denied one out of every eight prior authorization requests in 2019, according to a recent report by the HHS Office of Inspector General. Among the 115 MCOs reviewed, 12 MCOs that covered about 2.7 million enrollees had denial rates higher than 25%.

The report studied seven MCO parent companies with the greatest number of Medicaid enrollees across 37 states. Molina Healthcare, Inc. had the highest overall prior authorization denial rate at 17.7%, with seven of its 12 MCOs seeing denial rates greater than 25%.

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Jinghong Chen

Jinghong Chen Reporter

Jinghong has been producing infographics and data stories on employer-sponsored insurance, public health insurance programs and prescription drug coverage for AIS Health’s Health Plan Weekly and Radar on Drug Benefits since 2018. She also manages AIS Health’s annual executive compensation database for top insurers and Blue Cross and Blue Shield affiliates. Before joining AIS Health, she interned at WBEZ, Al Jazeera English and The New York Times Chinese. She graduated from Missouri School of Journalism with a focus on data journalism and international reporting.

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