Medicaid Managed Care and Providers' Perceptions of Quality of Care for Children with Chronic Conditions in Georgia

Medicaid managed care plans employ cost containment tools such as prior authorization and preferred drug lists to achieve cost savings. Little is known about these tools' effects on quality of care for beneficiaries with chronic conditions. We surveyed physicians and nurse practitioners based in federally qualified health centers (FQHCs) in Georgia to capture how they perceive these tools affect care and health outcomes for Medicaid-enrolled patients with chronic illnesses. We received 63 completed surveys, representing 19 (58%) of FQHCs in Georgia. Across multiple measures, 56.1–71.7% reported difficulties with prior authorization request denials, preferred medication prescribing, and specialist referrals "sometimes," "often," or "very often" when caring for patients with asthma. Greater difficulties with prior authorization request denials were associated with perceived poorer care quality (p=.03). Further research is needed to inform state policymaker decisions about potential restrictions on Medicaid managed care plans' use of cost containment tools with medically vulnerable beneficiaries.