New Report Highlights Need for Improved Medicaid Oversight

New Non-Partisan Watchdog Report Finds that Data Limitations Continue to Handicap Oversight Efforts

WASHINGTON, DC – A recent report from the nonpartisan Government Accountability Office (GAO) found that the Centers for Medicare & Medicaid Services (CMS) continues to rely on inaccurate, incomplete, and untimely Medicaid data. Released yesterday, the report outlines how such issues limit the agency’s ability to ensure that federal payments to states are proper and that Medicaid beneficiaries have access to services.

Following the release of the report, Senate Finance Committee Chairman Orrin Hatch (R-UT) and House Energy and Commerce Chairman Greg Walden (R-OR) issued the following statement:

“For the last 14 years, GAO has warned the Medicaid program is ‘high-risk.’ This GAO report reiterates that much work needs to be done to improve data integrity at CMS on the behalf of both taxpayer and patients. As the agency is soon to be under the direction of a new administrator, it is our hope CMS will work to implement the GAO’s recommendations as soon as possible.”

CMS's 2016 Actuarial Report estimated the federal government paid $363 billion in Medicaid expenditures and Medicaid covered 72 million beneficiaries in 2016. This same report projects that over the next 10 years, total federal and state expenditures “are projected to increase at an average annual rate of 5.7 percent and to reach $957.5 billion by 2025.”

Additional findings of the report include:

• GAO found that less than half of the states are submitting data to a new CMS data system designed to streamline and improve the quality of data reported by states to CMS.
• GAO’s report recommends that the administrator of CMS take immediate action to assess and improve the data that the agency relies on to conduct program oversight.

The GAO report was requested by a bipartisan group of members from the House Energy and Commerce and Senate Finance committees who recognize that having useful and timely data for program oversight is critical to better manage the Medicaid program. Since 2003, GAO has designated the Medicaid program as high-risk due to its size, concerns about the adequacy of fiscal oversight, and other criteria.

Medicaid was originally established to provide health care coverage to the nation’s most vulnerable citizens. Under this federal-state program, states have responsibility for daily operations and report various data to CMS, including data on expenditures and utilization of services.

Click HERE to read the GAO report.

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