States Could Better Leverage Coverage and Access Requirements To Promote Maternal Health Care Access in Medicaid Managed Care

Why OIG Did This Review

• The U.S. is experiencing a maternal health crisis, with worse outcomes here than in any other high-income country. Significant racial and geographic disparities exist in maternal deaths and complications. Access to maternal health care influences these outcomes.
• Medicaid is the Nation’s largest maternal health care payor and most pregnant enrollees are covered by managed care organizations (MCOs). States use provider coverage rules and network adequacy standards (i.e., requirements that MCOs include enough providers in their networks) to help ensure that enrollees have adequate access to care.

What OIG Found

States are not leveraging managed care provider coverage requirements and network adequacy standards to promote access to maternal health care. Access to maternal health care can support better health outcomes.

All States require their MCOs to cover obstetrician/gynecologist (OB/GYN) physicians and hospitals, but many States reported they do not require MCOs to cover other important types of maternal health providers and professionals, some of whose services are federally required.

Some States are not using network adequacy standards to address important dimensions of maternal health care access. For example, some States measure access to specific provider types such as OB/GYNs, but many States do not. Some States tailor their standards to maternal health care (e.g., by varying appointment wait time requirements by stage of pregnancy), while others do not.

All States reported monitoring MCOs’ compliance with network adequacy standards, but they may lack data on the standards’ impact on enrollees’ access to maternal health care.

What OIG Recommends

OIG recommends that CMS:

1. Take steps to confirm that all States cover required services from maternal health care providers for managed care enrollees.
2. Clarify the requirement that States have a provider-specific OB/GYN network adequacy standard.
3. Support States in tailoring their network adequacy standards to better address maternal health care needs.

CMS concurred with all three recommendations.