Standards for Provider Network Adequacy in Medicaid and the Marketplaces

The Centers for Medicare & Medicaid Services (CMS) has issued final rules for provider network adequacy in Qualified Health Plans (QHPs) offering coverage in the marketplaces that the federal government operates through HealthCare.gov.

This blog compares the standards for network adequacy in Medicaid with those in the marketplaces, finding that, on paper, the standards for the adequacy of MCOs in Medicaid are stronger than those for QHPs in the marketplaces.