4. How Medicaid’s networks could change
Health insurers that run state Medicaid programs must have adequate networks of doctors so people don’t have to travel far. But that may change under a new federal proposal, Axios’ Bob Herman reports.
How it works: An Obama-era rule required states to come up with “time and distance” standards for Medicaid networks.
- But now, the Centers for Medicare & Medicaid Services proposes eliminating that “time and distance” requirement and replacing it with broader “quantitative standards,” like maximum wait times or whether doctors are accepting new Medicaid patients.
What they’re saying: “We aren’t rolling back [network] requirements,” CMS Administrator Seema Verma said in a response on Twitter.
- Insurers have said time and distance standards, especially for rare medical specialties, are hard to create for rural areas.
The bottom line: This rule could allow states to create new rules under which the nearest doctors are hundreds of miles away, resulting in “much less adequate provider networks than under the current rule,” said Edwin Park, a Medicaid researcher at Georgetown University.