Medicaid consumers, providers, managed care organizations, and states all have an interest in ensuring access to specialty care for Medicaid beneficiaries. We sought to interrogate the national Transformed Medicaid Statistical Information System (TMSIS) database to learn more about specialty provider networks and examine the provision of specialty services across various states. The concentration of specialty services among Medicaid specialty providers may inform strategies for both MCOs and state policy makers in building stronger networks, clarifying the provisions of network adequacy, and developing policies to assess and regulate access to specialty care. Our analysis of TMSIS data showed significant concentration of selected specialty services among providers. The methodology may be useful for future analysis to monitor network stability and compare access among various payers.
Other report contributors include HMA Principal Margaret Kirkegaard and HMA Managing Director Matt Powers.