Robert Besser
06 Mar 2025, 15:09 GMT+10
ANNAPOLIS, Maryland: Maryland's largest managed care organization for Medicaid recipients has had its accreditation suspended, prompting state officials to pause new enrollments and allow existing members to switch plans.
Priority Partners, which covers approximately 350,000 Medicaid enrollees—about 24% of Maryland's 1.5 million Medicaid recipients—was suspended due to concerns related to provider credentialing and quality reviews, according to the Maryland Department of Health.
The suspension does not impact existing coverage or access to care for current members, but the state will not allow new enrollments into Priority Partners starting March 17, said Ryan Moran, the state's Deputy Secretary of Health Care Financing and Medicaid Director.
"We will be following up with communication to those members," Moran told The Associated Press, adding that the state will also post information online to keep enrollees informed of their options.
Current members will have a 60-day window to switch to another managed care organization if they choose.
The National Committee for Quality Assurance (NCQA), an independent nonprofit that evaluates and reports on health plan performance, took action against Priority Partners MCO due to concerns about compliance with quality standards.
"NCQA has suspended Health Plan Accreditation for Priority Partners MCO until they implement corrective action and undergo a resurvey," the nonprofit said in a statement. "Details of the suspension cannot be disclosed."
According to the Maryland Department of Health, Priority Partners is the only Medicaid managed care organization in the country to have its accreditation suspended.
Moran emphasized that maintaining high-quality healthcare standards is a priority for the state.
"The sanctions on Priority Partners ensure that Marylanders across the state receive top-quality care," he said, adding that the suspension will remain in effect until the NCQA deems that corrective actions have been successfully implemented.
Priority Partners has not yet responded to requests for comment regarding the accreditation suspension.
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