Assessing Federal and State Network Adequacy Standards for Medicaid and the Marketplace

This brief reviews the regulatory framework governing network adequacy standards for Medicaid Managed Care Organizations and Marketplace qualified health plans while identifying policies and practices to ensure networks include the number and mix of providers that enrollees need.

For health insurance to be meaningful, enrollees must have access to providers that can meet their needs. However, there is little consensus over what network adequacy means in practice, what standards should be used to assess it, and how those standards should be enforced.