GAO Urges CMS To Act on Recommendations To Improve Medicaid
The Government Accountability Office in a report released Thursday identified more than 80 recommendations it made to CMS to improve Medicaid, noting CMS has only implemented some of the suggestions, Modern Healthcare's "Vital Signs" reports.
GAO said the unimplemented recommendations could help to bolster Medicaid's oversight and security (Dickson, "Vital Signs," Modern Healthcare, 7/31). The report looked at recommendations made in four areas:
- Access to care;
- Automatic funding increases;
- Fraud prevention; and
- Transparency and accountability (Frieden, "The Gupta Guide," MedPage Today, 7/31).
- GAO suggested CMS improve oversight of state Medicaid waivers, which could be responsible for billions of dollars in unneeded federal spending; and
- GAO recommended CMS gather more insight on how states are funding their portions of Medicaid, with additional data needed to make sure states are complying with federal requirements mandating how much local governments can contribute.
The report noted, "Given states' increased reliance on non-state sources to fund the non-federal share of Medicaid, which can result in costs shifting to the federal government, we continue to believe that data are needed to improve transparency and oversight, such as to understand how increased federal costs may affect beneficiaries and the providers who serve them" ("Vital Signs," Modern Healthcare, 7/31).
Further, the report highlighted the need for CMS to:
- Create a federal-state partnership to focus on preventing fraud in traditional fee-for-service and managed care plans under Medicaid;
- Develop an automated process through which states would receive annual funding increases for their Medicaid programs;
- Ensure Medicaid beneficiaries have adequate access to care, including dental care, by making sure states work to improve provider networks; and
- Gather more data on and have greater oversight over Medicaid reimbursements to providers.
Overall, the report noted, "The size, growth and diversity of the Medicaid program create significant challenges for oversight." The report added, "Attention to the issues facing Medicaid and the effectiveness of its federal-state partnership will be important for ensuring that Medicaid is both effective for the enrollees who rely on it and accountable to the taxpayers" ("The Gupta Guide," MedPage Today, 7/31).
GAO suggested CMS act on its recommendations as quickly as possible, especially given growing Medicaid enrollment under the Affordable Care Act. In addition, GAO noted it would be releasing more recommendations in the future, as it currently is conducting multiple studies on Medicaid ("Vital Signs," Modern Healthcare, 7/31).
Matt Salo, executive director of the National Association of Medicaid Directors, said GAO did not raise any issues "relevant to the day-to-day operation" of Medicaid. He added, "GAO struggles to understand and quantify Medicaid because it is a complex program with multiple moving pieces." He said, "The kinds of things that GAO seems to be implying -- transparent checklists of things that are approvable, or picture perfect tidy accounting of every penny -- simply don't recognize or appreciate the vast complexity of the system and the fundamentally different health care systems, cultures and financing mechanisms of 50 [plus] states," concluding, "Implementing their recommendations would be a step backwards" ("The Gupta Guide," MedPage Today, 7/31).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.