New Georgetown Report on Medicaid and Marketplace Network Adequacy


For health insurance to be meaningful, enrollees must have access to providers that can meet their health care needs. Yet a new study from Georgetown University’s Center on Health Insurance Reforms (CHIR) and Center for Children & Families (CCF) evaluated federal and state standards for network adequacy across Medicaid and the Marketplaces and found that access to providers can vary considerably, depending on what kind of coverage you have and where you live. Of note, the study finds that:

  • Federal standards for network adequacy are much stronger for Medicaid Managed Care Organizations than they are for Marketplace plans.
  • Standards for and oversight of plan network adequacy varies dramatically across states.
  • There are minimal federal standards for the inclusion of essential community providers in plan networks, and no federal standards to ensure that enrollees receive care from a diverse network of providers that can meet their cultural or linguistic needs.

The report includes several recommendations for federal and state policymakers to improve network adequacy and help give consumers confidence that they can access the care they need, when they need it.

You can read the full report here.

This report was made possible thanks to the generous support of the Robert Wood Johnson Foundation.





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