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In providing care to 3.6 million Medicaid customers, Illinois hospitals have seen the negative impact of managed care organizations’ (MCOs) prior authorization practices. It’s one of the biggest barriers to healthcare for children, people with disabilities, seniors and other adults with Medicaid coverage, who are disproportionately people of color.

Inappropriate denials that lead to delayed care can worsen an individual’s health and lead to poor outcomes. Prior authorization can also exacerbate health disparities and “create barriers to care for medically underserved patients, patients of color, LGBTQ+ patients, patients in rural areas, and those at risk for poor health outcomes,” according to the American Academy of Pediatrics.

What’s more, MCOs deny coverage requests for needed procedures or medical tests at twice the rate of Medicare, according to a 2023 U.S. Dept. of Health and Human Services study. The Illinois Health and Hospital Association urges lawmakers to pass legislation that addresses harmful prior authorization practices and eliminates barriers to healthcare for Illinois’ most vulnerable populations.

Medical decisions should be in the hands of patients and medical professionals, not insurance companies that reduce costs and increase profits by denying care that doctors recommend. Support IHA’s MCO prior authorization reforms.