A recently published study takes a closer look at the state of prior authorization practices in state Medicaid managed care programs.

The survey explored prior authorization decision time frames, the use of electronic denial notices, patient access to external medical review, and processes and time frames for prior authorization decisions and appeals based on federal Medicaid managed care rules.

Among the survey’s findings:

  • “Nearly half of responding states (17 of 36) reported requiring standard prior authorization decisions within 7 calendar days (18 states) or a shorter timeframe (9 states).
  • “About one-third of responding MCOs [managed care organizations] (12 of 38) require MCOs to offer electronic denial notices.”
  • “More than half of responding MCO states (21 of 38 states) reported using standardized prior authorization denial notice templates or language.”
  • “As of July 1, 2024, at least one-third of responding MCO states (15 of 39) provided enrollees access to an independent, external medical review process to review an MCO’s decision to uphold a denial.”

Learn more about the state of prior authorization in Medicaid managed care and how the states manage their individual prior authorization process from the KFF report “Prior Authorization Process Policies in Medicaid Managed Care: Findings from a Survey of State Medicaid Programs.”