Medicaid Network Adequacy & Provider Development
Build Stronger Medicaid Networks. Improve Provider Access. Prepare for Expansion.
MyQualityCareNetwork helps Medicaid managed care organizations evaluate provider access against state-specific requirements, develop primary care, specialty, behavioral health, and LTSS networks, and prepare for procurement and market expansion.
Medicaid Managed Care Network Adequacy
Federal rules require state Medicaid programs to set network adequacy standards for managed care plans, but each state defines its own provider access requirements — and they differ by program, population, and geography. What counts as adequate in one state's contract may not satisfy another's.
We evaluate your network against the specific standards in your state Medicaid contract — not a generic benchmark — so the analysis reflects the rules your plan is actually held to.
Medicaid Provider Network Development
Primary care and specialists
Development of primary care and specialty networks sized to your enrolled population and your state's access requirements.
Behavioral health
Behavioral health network development across outpatient, intensive, and crisis service levels.
Facility networks
Hospital, nursing facility, and ancillary facility coverage evaluated alongside your professional network.
Community-based providers
Identification and development of the community-based organizations Medicaid members rely on day to day.
Provider contracting
Practical contracting support — from target identification through executed agreements.
Whole-network view
Every category measured together, so a strong primary care network doesn't hide a specialty shortfall.
LTSS and MLTSS Network Development
Long-Term Services and Supports networks are among the hardest to build and the most scrutinized in Medicaid procurement. We support Managed Long-Term Services and Supports network development with attention to the provider types these programs depend on.
Home- and community-based services
Development of HCBS provider networks — personal care, home health, adult day, and related community services — with geographic access in mind.
Long-term care access
Nursing facility and institutional long-term care coverage evaluated for the populations your MLTSS program serves.
Our network development strategies account for the realities of LTSS markets: thin provider supply in rural areas, workforce constraints, and the state-specific credentialing and contracting requirements these providers face.
Medicaid Market Expansion and Procurement Readiness
Medicaid RFP planning
Network analysis and documentation prepared to support your response to state Medicaid procurements.
New-market evaluation
Before you bid, see the provider supply and access landscape in the regions you are considering.
Post-award development
After a contract award, rapid network build-out against the timelines your state contract sets.
Regional expansion
County-by-county expansion planning that shows where your existing network carries over and where it doesn't.
Contracting strategies
Provider contracting strategies sequenced to meet procurement and readiness review milestones.
Geographic Network Gap Analysis
We apply geographic access methodologies — drive time, distance, and provider-to-member ratios — to show where your Medicaid network falls short, down to the ZIP code level.
Importantly, Medicare Advantage CMS time-and-distance thresholds are not Medicaid standards. Each state sets its own Medicaid access requirements, and our analysis is configured to the standards in your state contract rather than borrowed federal MA benchmarks.
Medicaid Provider Contracting Strategy
Closing a Medicaid network gap takes more than a list of names. We provide practical support across the full contracting cycle: identifying the right providers in the market, prioritizing them by estimated member impact, supporting recruitment and negotiation, and tracking network development progress against your state's requirements.
Your internal contracting team can run the strategy with our analysis, or our network development team can pursue candidates on your behalf.
State-Specific Regulatory Considerations
Medicaid is fifty-plus different programs, not one. Provider access standards, reporting formats, network file layouts, and readiness review processes are set by each state's contract — and they change from procurement to procurement. We tailor every analysis and deliverable to the specific requirements of the state you operate in, and we say so plainly when a requirement differs from another state's approach.
Our Four-Step Process
Assess
Measure your current network against the access standards in your state Medicaid contract.
Prioritize
Rank gaps by estimated member impact so development effort goes where it matters most.
Develop
Identify, recruit, and contract the providers estimated to close the most access gaps.
Validate
Re-measure as the network changes and prepare documentation for readiness reviews and state reporting.
Built by Healthcare Network Leadership. Designed for Health Plan Challenges.
MyQualityCareNetwork combines data-driven geographic network analysis with decades of hands-on managed care executive experience.
Our approach draws on expertise in Medicare Advantage, Medicaid managed care, provider network contracting, geographic expansion, regulatory reporting, and network operations.
Identifying a network deficiency is only the beginning. Our focus is on developing practical strategies that help health plans prioritize contracting opportunities, strengthen provider relationships, and improve network readiness.
Learn more about us
Felix Gonzalez
Founder, MyQualityCareNetwork
- More than 30 years of managed care experience
- Provider network development leadership
- Medicare Advantage network experience
- Medicaid managed care contracting
- Network expansion initiatives
- CMS HSD and adequacy experience
- Provider network operations
- Executive leadership
Request a Medicaid Network Consultation
Tell us the state, program, and regions you are evaluating, and we will show you where your network stands against your state's requirements — and what it would take to close the gaps.
Keep exploring
- For Health Plans — the full range of network solutions for MA and Medicaid plans.
- Insights — articles on network adequacy, contracting, and expansion.
- Contact — start a conversation about your network.
Build the network before the gap shows up on a CMS report.
Whether you're a behavioral health provider exploring network participation opportunities or a health plan starting plan access discussions, we'd like to hear from you.