HHS OIG: Many Medicare Advantage and Medicaid Managed Care Plans Have Limited Behavioral Health Provider Networks and InactiveProviders
Why OIG Did This Review
• Medicare and Medicaid play significant roles in ensuring access to care for millions of enrollees with behavioral health conditions, which include mental health disorders and substance use disorders.
• Most Medicare and Medicaid enrollees’ behavioral health care is covered by managed care plans. As a result, enrollees’ access to providers is largely determined by the network of providers contracted by each plan.
• Plans must provide enrollees with a list of all providers in their network, i.e., a network directory. This review assessed the extent to which selected plan networks were limited and whether the providers listed in each directory were actively providing services to the plan’s enrollees.