June 3, 2026  – A new analysis of Medicaid managed care oversight suggests that sanctions imposed on health plans may not always result in meaningful corrective action, raising concerns about accountability within one of the nation’s largest public health programs.

The study, published in The American Journal of Managed Care, examined publicly available Medicaid Managed Care Program Annual Reports submitted to the Centers for Medicare & Medicaid Services (CMS). Researchers reviewed data from 20 states and one U.S. territory and found that approximately one-quarter of sanctions issued against Medicaid managed care organizations (MCOs) remained unresolved.

The findings come as Medicaid managed care continues to dominate the delivery of services across the country. More than 78 million Americans receive health coverage through Medicaid, and roughly 72% of beneficiaries are enrolled in managed care plans operated by private organizations. These plans are responsible for providing services to low-income children, adults, older adults, and individuals with disabilities under contracts with state Medicaid agencies.

States use sanctions as a primary enforcement tool when managed care organizations fail to comply with contract requirements, regulatory standards, or quality expectations. Penalties can range from corrective action plans and financial fines to enrollment freezes and contract-related actions. The goal is to ensure that public funds are used appropriately and that beneficiaries receive the services and care promised under Medicaid contracts.

However, the study found substantial differences among states in how sanctions are applied, tracked, and resolved. Researchers noted that reporting practices varied widely, making it difficult to compare enforcement efforts across states or assess whether sanctions ultimately improve plan performance. In some cases, states provided detailed information about violations and corrective actions. Others offered limited data regarding the outcome of enforcement measures.

The analysis suggests that unresolved sanctions may weaken the effectiveness of state oversight efforts. If corrective actions are not completed or enforcement actions are not consistently monitored, problems identified within managed care plans could persist over time. Researchers pointed to the need for stronger transparency and greater consistency in reporting requirements.

The study also highlights broader questions about Medicaid managed care accountability as states increasingly rely on private health plans to administer benefits. Managed care organizations receive billions of dollars in public funding each year and play a critical role in determining access to care, provider networks, claims processing, and quality improvement activities.

According to the researchers, stronger federal guidance could help standardize how sanctions are reported and monitored. More consistent reporting would allow policymakers, regulators, providers, and beneficiaries to better understand how often plans fail to meet requirements and whether enforcement actions lead to meaningful improvements.

The findings arrive amid growing scrutiny of Medicaid managed care oversight nationwide. Several recent audits, investigations, and policy reviews have examined issues related to payment accuracy, network adequacy, quality performance, and beneficiary access to care. As states continue expanding the role of managed care within Medicaid, oversight mechanisms are expected to remain a central policy focus.

Researchers concluded that sanctions remain an important accountability tool, but their effectiveness depends on consistent enforcement, transparent reporting, and timely resolution. Without stronger oversight and clearer standards, they warned, states may have difficulty ensuring that managed care organizations fully meet their obligations to Medicaid beneficiaries and taxpayers.