[The following is a paid advertisement.]

As enrollment in Medicaid managed care organizations (MCOs) has grown, so have concerns with MCOs inappropriately delaying or denying care for thousands of patients—including cancer patients, people with cardiac conditions, elderly patients and people with disabilities.

In a 2023 study, the U.S. Dept. of Healthcare and Human Services Office of Inspector General (OIG) found that, on average, the MCO denial rate was over twice that of Medicare. The study said, “Prior authorization can be used to manage costs by denying services that the MCO judges to be inappropriate or not medically necessary. However, Federal regulations stipulate that prior authorization may not be used to arbitrarily restrict access to medically necessary services covered by the MCO’s contract.”

The Illinois Health and Hospital Association (IHA) agrees with the OIG. Illinois MCOs are using unnecessarily burdensome prior authorization policies to manage their costs, instead of coordinating care.

IHA’s legislative reform package is a commonsense approach to addressing issues that have made prior authorization a top challenge to providing healthcare to Medicaid patients.

Learn about IHA’s MCO reform package and see how MCO practices have impacted Illinois patients and providers. Illinois’ 3.6 million Medicaid patients need YOUR support to achieve optimal health!