ArticleThe American journal of managed care2022
Variation in network adequacy standards in Medicaid managed care.
Article in The American journal of managed care, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
What it found
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed.
- Geographic Availability and Use of Medications for Opioid Use Disorder Among Medicaid Enrollees.JAMA health forum · 2026Article
- Predicting pharmacy choice for managed care network design.Journal of managed care & specialty pharmacy · 2026Article
- Comparing health care utilization after hospital discharge in Medicaid managed care versus fee-for-service.Health affairs scholar · 2026Article
- Health care access from the rural perspective: A narrative review.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2026Review
- Policy brief: AI-first Medicaid: how CMS can build a smarter safety net with Precision Benefits.NPJ digital medicine · 2025Article
- ACA network regulatory filings are inaccurate, poorly match provider directories.The American journal of managed care · 2025Article
- Spatial accessibility of substance use disorder treatment programs, compared with other health care facilities, in New York State, 2024.Addiction science & clinical practice · 2025Article
- Medicaid managed care organizations' experiences with network adequacy.Health affairs scholar · 2025Article
- Article
- The Status of Children's Dental Health in Rural Appalachian West Virginia.Journal of Appalachian health · 2025Article
- Dental care access for children in the United States.Journal of public health dentistry · 2024Article
- Rural and frontier access to mental health prescribers and nonprescribers: A geospatial analysis in Oregon Medicaid.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2024Article
- New Opportunities to Strengthen Medicaid Managed Care Network Adequacy Standards.JAMA health forum · 2023Article
- State Policy and the Breadth of Buprenorphine-Prescriber Networks in Medicaid Managed Care.Medical care research and review : MCRR · 2023Article
- Psychiatrist Networks In Medicare Advantage Plans Are Substantially Narrower Than In Medicaid And ACA Markets.Health affairs (Project Hope) · 2023Article
- Jumping Through Hoops: Community Care Clinician and Staff Experiences Providing Primary Care to Rural Veterans.Journal of general internal medicine · 2023Article
- Phantom Networks: Discrepancies Between Reported And Realized Mental Health Care Access In Oregon Medicaid.Health affairs (Project Hope) · 2022Article
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
objectivesTo describe the types and breadth of network adequacy standards used by state Medicaid programs with managed care arrangements. STUDY
designDocument analysis of Medicaid provider network reports, managed care plan contracts, access monitoring review plans, Medicaid services manuals, quality strategy reviews, and state statutes and regulations.
methodsWe analyzed 52 primary documents from 2017 to 2020, representing 39 of the 40 states (including the District of Columbia) with Medicaid managed care. We conducted descriptive analyses of network adequacy standards, variation in standards by type of provider, timely access standards, nonquantitative network access standards, and monitoring or enforcement plans.
resultsA majority (89.7%) of states applied time and distance standards for network adequacy, stratified by population size or geography. Time and distance standards ranged from 15 to 90 minutes for a primary care provider (mean, 44.7 minutes in rural areas and 28.9 minutes in urban areas) to 30 to 135 minutes for a cardiologist (mean, 72.1 minutes in rural areas and 40.4 minutes in urban areas). Most states also used timely access or appointment availability standards. Relatively few states applied other quantitative standards, such as provider to enrollee ratios, or provided detailed enforcement plans in cases of poor compliance.
conclusionsMost states use travel time and distance to account for local contexts and geographies, but there is considerable variation across Medicaid programs. Several states do not publicize their network adequacy regulations, or they rely on qualitative standards despite federal requirements. For network adequacy to be meaningful, states must balance the tension between flexibility and accountability and ensure that regulations are monitored and enforced accordingly.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.