Medicaid Managed Care Hospital Networks in Missouri: Too Far to Travel

Saint Louis University Center for Health Law Studies & WashU Center for Advancing Health Services, Policy & Economics Research* | August 2021

*Formerly Center for Health Economics and Policy

Three Medicaid managed care organizations (MCOs)—Healthy Blue, Home State Health, and
UnitedHealthcare—serve Medicaid beneficiaries across Missouri. To assure that enrollees have adequate access to in-network providers, Medicaid MCO contracts and state regulations
require that each health plan have geographically accessible in-network hospital service. Basic hospital services, such as an emergency department, should be available to enrollees within 30 miles; secondary hospital services within 50 miles; and Trauma I/II, neonatal intensive care, and other highly specialized tertiary hospital services within 100 miles.

However, all 3 Medicaid MCOs report being unable to offer networks that meet hospital travel
distance standards in significant, often contiguous swaths of the state. One fundamental
problem is a shortage of hospitals offering basic and tertiary services in some communities.
Another problem with a more readily available remedy is that certain hospitals do not contract with one or more Medicaid MCOs. In either case, when Medicaid MCOs cannot meet network standards, Medicaid enrollees are forced to travel longer distances to access care.