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7 reports
Overall, we found an increase in the number of pregnant women in Louisiana who did not receive prenatal care as recommended, with pregnant Medicaid beneficiaries representing a disproportionate share of women without prenatal care.
LDH’s design and lack of oversight of the MCIP program led to the majority of MCIP funds being paid for activities that do not have a direct, measurable result for how they improve access to healthcare, improve quality of care, or enhance the health of Medicaid beneficiaries.
The informational brief presents a comprehensive analysis of DentaQuest’s performance as the Medicaid dental benefit program manager, highlighting ongoing concerns with network adequacy, claims processing and denials, provider credentialing, and contract compliance, while noti…
The audit found significant governance and data-use gaps in LDH’s oversight of Medicaid MCOs, including incentive design that can pay for non-improving performance, lack of data-driven identification of non-utilizing beneficiaries and preventive service gaps, fragmented compla…
Overall, the audit concludes that the Louisiana Department of Health should improve its processes for identifying and removing Medicaid beneficiaries who no longer reside in Louisiana, as substantial PMPM payments were made to out-of-state-residing beneficiaries and related ou…
LDH has not implemented the use of federal tax information for MAGI-based Medicaid eligibility determinations as of August 2019. The agency has ceased automated use in LaMEDS, awaiting IRS approvals and addressing security and space requirements. The IRS-compliant environment…
All issues identified in this report exist because the MCOs, Magellan, and LDH have not established sufficient edit checks to ensure claims and encounters that do not comply with the fee schedule are denied. LDH states that post-pay reviews and other analytics are in place, bu…