Maryland’s largest provider for Medicaid enrollees gets its accreditation suspended

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This article was published 28/02/2025 (284 days ago), so information in it may no longer be current.

ANNAPOLIS, Md. (AP) — Maryland’s largest managed care organization for Medicaid enrollees has had its accreditation suspended due to concerns with credentialing and quality reviews for its providers, a state health department official said Friday.

A managed care organization is a health care company or plan that aims to control health care costs by supervising the delivery of care through a network of contracted providers.

Priority Partners has about 350,000 enrollees in Medicaid, or about 24% of Maryland’s roughly 1.5 million enrollees in the government-funded health insurance program for low-income people, according to the health department.

The suspension does not affect coverage benefits or access to care for current members in the plan, but the state is suspending any new enrollment into Priority Partners as of March 17, said Ryan Moran, deputy secretary of health care financing and Medicaid director for the state’s health department.

Priority Partners is the only Medicaid managed care organization in the nation with an accreditation suspended, according to the health department. The company did not immediately return a call seeking comment.

Starting March 17, anyone enrolled in Priority Partners will have a 60-day window to switch to another managed care organization in the state, Moran said. He also said the state will notify current enrollees of their right to change plans if they want.

“We will be following up with communication to those members,” Moran told The Associated Press on Friday. “We will also be posting information on our website.”

Priority Partners’ accreditation was suspended by the National Committee for Quality Assurance, which is an independent nonprofit that measures and reports on a plan’s performance.

“NCQA has suspended Health Plan Accreditation for Priority Partners MCO until they implement corrective action and undergo a resurvey,” the nonprofit wrote in an email. “Details of the suspension cannot be disclosed. Further action is at the discretion of the Maryland Department of Health.”

Managed care organizations in Maryland are required to maintain and report on their accreditation with the NCQA, which Moran called “the gold standard of evaluation in this regard.”

He said the sanctions on Priority Partners “ensure that Marylanders across the state receive top-quality care,” and will remain in effect until the nonprofit oversight committee lifts the suspension.