States Push Back Against Medicaid Managed Care

This episode of Code Whack examines the growing pushback from states against Medicaid managed care organizations (MCOs), which act as private insurers intermediating between states and healthcare providers. Host Brenda Gazar speaks with Dr. Alan Creda Olson of Physicians for a National Health Program (PNHP), who argues that MCOs undermine care coordination due to narrow networks, delayed reimbursements, and bureaucratic hurdles—especially evident in Oklahoma, where the shift to managed care has led to physician burnout and reduced access. The episode highlights PNHP's report, 'Removing the Middlemen from Medicaid,' which advocates for state-led or provider-led administration of Medicaid to cut waste, improve access, and save hundreds of millions in administrative costs. States like Minnesota, Maryland, Ohio, Illinois, and others are actively exploring legislative or administrative changes to phase out MCOs, with Connecticut serving as a successful model that achieved deprivatization in just one year using administrative service organizations. The shift promises better patient access, increased physician participation, and fewer prior authorizations used to delay or deny care. The episode underscores a broader movement toward healthcare reform, driven by bipartisan support, grassroots advocacy, and mounting pressure from federal funding cuts and mandates like work requirements. Dr. Olson emphasizes that deprivatizing Medicaid isn't just about cost savings—it’s about restoring dignity and functionality to the system. The response from physicians, patient advocates, and even Republican lawmakers reflects a rare convergence of political will. The episode concludes with a call to action: states can make meaningful change quickly by building coalitions, educating policymakers, and leveraging existing administrative flexibility. It’s a hopeful narrative about systemic reform rooted in practical, achievable steps.