US representative launches investigation into Medicaid prior authorization denials

By Claire Wallace / August 18, 2023

Rep. Frank Pallone Jr., a Democrat from New Jersey, has announced an inquiry into the high rate of prior authorization denials by Medicaid managed care plans. 

"I’m deeply troubled by reports that Medicaid managed care plans denied an average of one out of every eight requests for treatment, more than double the rate of service denials in Medicare Advantage," Mr. Pallone said in a statement on his website released Aug. 17. 

In July, the Health and Human Services Office of Inspector General released a report that raised concerns some individuals enrolled in Medicaid managed care might not be receiving all medically necessary services due to high rates of prior authorization denials. 

Currently, over 80 million Americans are on Medicaid, according to the release. 

"I will be contacting each of these health insurance companies directly for additional information and questions regarding their prior authorization practices. It is essential that these state contracted plans are upholding their responsibility to patients and their families," Mr. Pallone said.