Medicaid managed care
Medicaid managed care is when a state pays private health plans, called managed care organizations (MCOs), to deliver Medicaid benefits through their own provider networks. Federal rules require these plans to publish provider directories and keep them current.
What must a Medicaid managed care directory include?
Under 42 CFR 438.10, each provider listing must include, among other things, the provider's name and group affiliation, street address, phone number, website, specialty, whether they will accept new enrollees, the languages offered, and whether the office is accessible for people with disabilities.
How often must it be updated?
An electronic directory must be updated no later than 30 calendar days after the plan receives updated provider information. Directories must also be available in a machine-readable format.
Why does it matter?
Medicaid members often have fewer options and less flexibility to try another provider, so a wrong listing can mean a long delay in care.