States Gain Flexibility to Use Contractors for Medicaid Eligibility Decisions.
This law allows states to hire private companies or other agencies to handle Medicaid applications and appeals. Crucially, safeguards are included to prevent these contractors from delaying decisions or unfairly denying benefits. The goal is to potentially speed up access to health coverage for eligible citizens while protecting them from conflicts of interest.
Key points
States can now contract out the process of determining who qualifies for Medicaid benefits and handling related appeals (fair hearings).
Strict conflict of interest rules are established: contractors deciding eligibility cannot have financial ties to Medicaid managed care providers (MCOs).
Contracts must prohibit incentives that encourage contractors to delay or deny health benefits to eligible applicants.
Introduced
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