Medicaid managed care organizations' experiences with network adequacy.

ABSTRACT: Access to behavioral health care continues to be a challenge in Medicaid, where most enrollees are restricted to networks of providers and facilities contracted with managed care organizations (MCOs). While state and federal regulations have sought to ensure access to care, little is known about how health plans perceive and respond to these network adequacy standards. We interviewed 27 administrators and executives across 19 local, regional, and national Medicaid MCOs to assess their behavioral health networks and perceived barriers and facilitators in these efforts. We purposively sampled MCOs for maximum heterogeneity, with early findings used to refine subsequent recruitment targets until thematic saturation. We used an iterative inductive coding approach with code discrepancies analyz

SUBMITTER: Zhu JM 

PROVIDER: S-EPMC11970020 | biostudies-literature | 2025 Apr

REPOSITORIES: biostudies-literature