While states are required to collect data on grievances and appeals filed by Medicaid beneficiaries over denied care, they are not required to collect the outcomes of these appeals, according to a report from the GAO published March 14.
CMS has also made “limited progress” on plans to analyze data from states and make this data public, the GAO said.
In its report, the government watchdog recommended CMS require states to report the outcome and number of care denials in Medicaid and move forward with plans to make this data public.
On average, Medicaid managed care plans deny 12.5% of prior authorization requests, according to a 2023 report from HHS’ Office of Inspector General.
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