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Medicaid Managed Care Consumer Protection Regulations: No Patients' Rights for the Poor

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Publication Date: May 2001

Publisher(s): Families USA

Author(s): Peggy Denker; Judith G. Waxman; Jeff Crowley

Topic: Health (Health services for low income people)

Type: Report

Abstract:

Millions of low-income Americans stand to lose vital health care consumer protections if the Bush Administration refuses to implement--or significantly weakens--pending Medicaid managed care regulations. The regulations implement provisions of the Balanced Budget Act of 1997 (BBA), which included the most sweeping changes to Medicaid since the program was created 36 years ago. In essence, the BBA gave states the ability--without first having to obtain federal approval--to require Medicaid beneficiaries to enroll in managed care plans. In exchange, beneficiaries were given substantial new consumer protections. The consumer protection provisions were, in effect, a quid pro quo for the additional flexibility granted to the states in how they could administer their Medicaid programs. As 41 Members of Congress observed in a letter to Health and Human Services Secretary Tommy Thompson, "Congress struck a careful balance by matching new flexibility with meaningful patient protections." Now this "careful balance" is being threatened as the Administration delays action on the regulations.