Federal Watchdog: Medicaid Prior Authorization Denials Are Too Common

Medicaid managed care beneficiaries face “high rates of prior authorization denials” and “limited state oversight” of prior authorization, according to a notable new report from the HHS Office of Inspector General (OIG). Medicaid experts who reviewed the report say it demonstrates that Medicaid members and safety net providers may not be able to appeal denials for administrative reasons, and they add that states must do more to facilitate appeals to and prevent inappropriate denials by contracted plans. 

The OIG found, in a review of 2019 claims data from seven multistate carriers, that the studied MCOs “fully or partially denied approximately 2.2 million requests for the prior authorization of services,” amounting to one out of every eight requests, or 12.5% of all prior authorization requests. That rate was more than double the Medicare Advantage prior authorization denial rate of 5.7% in 2019, according to the OIG report published July 17.