From the U.S. Government Accountability Office, www.gao.gov

Transcript for: Medicaid Key Challenges

Description: Audio Interview by GAO staff with Carolyn Yocom, Director,
Health Care

Related GAO Work: GAO-15-677: Medicaid: Key Issues Facing the Program

Released: July 2015


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[ Narrator: ] Welcome to GAO's Watchdog Report, your source for news and
information from the U.S. Government Accountability Office. It's July,
2015. Medicaid turns 50 this month. The program has grown to be one of
the largest sources of healthcare coverage and financing for diverse,
low income, and medically needy populations. Today, it is undergoing
transformative changes after its expansion under the Affordable Care
Act. A team co-led by Carolyn Yocom and Katherine Iritani, directors in
GAO's Health Care team, recently looked at key issues facing Medicaid.
GAO's Jacques Arsenault sat down with Carolyn to talk about what they
found.

[ Jacques Arsenault: ] Can you talk a little about the size and scope of
Medicaid?

[ Carolyn Yocom: ] Sure, it's a large program. Medicaid is over $508
billion in spending in 2014, and then during the course of 2013, 72
million individuals participated in the program at some point during the
year. Medicaid has a pretty rich benefit package, as well. Unlike a lot
of private insurance coverage, it does cover long-term care services and
other types of services beyond routine doctor's visits.

[ Jacques Arsenault: ] And so how has the program changed over the
years?

[ Carolyn Yocom: ] When Medicaid was first enacted, the coverage was
primarily for individuals who were in certain categories. These
categories were things like being a child, being a person who is
elderly, and/or being a person with disabilities, and then there was
always an income test that was applied to the program, as well. With the
Affordable Care Act, the states now have the option of not using
categories of eligibility, and instead, focusing simply on income.

[ Jacques Arsenault: ] Now, GAO has done a lot of work on Medicaid over
the years, and in this report, it really is kind of looking at that body
of work. Can you talk about the four key issues or areas that you
highlighted in this report?

[ Carolyn Yocom: ] Right. The first issue does have to do with
maintaining and increasing access to care. Our work has very much found
that individuals on Medicaid have care comparable with that perceived by
individuals on private insurance, with a couple of key exceptions.
Primarily, specialty services such as mental health and dental care.
Secondly, we talk about fiscal accountability, and in particular, what
we really need here is better data to understand where the money in the
Medicaid program is going. Third, we talk about program integrity. There
is 17.5 billion estimated improper payments, and while there's been
progress made, we highlight, in particular, areas looking at
managed-care, both payments and oversight of managed-care payments. And
lastly, we talk about addressing variations in state spending needs, and
this is very specific to economic downturns. During a recession, states
have less money to with which to finance their program, but enrollment
in the program goes up. What GAO has suggested that Congress consider is
a formula that would automatically target assistance to states who have
lost revenues as a result of the recession. This would be temporary
assistance that would then be turned off when recovery occurred.

[ Jacques Arsenault: ] So then, what recommendations has GAO made to CMS
to improve Medicaid?

[ Carolyn Yocom: ] Well, we've made a lot of recommendations. We have
over 80 of them, and this report highlights 24 of them that cover each
of these four areas. We do recommend that demonstration spending be
budget neutral and be more oversight and be in place. We have
recommendations in the program integrity area, and we also have some
matters for the Congress to consider enacting, as well.

[ Jacques Arsenault: ] And finally, 50 years after Medicaid was
established, what would you say is the bottom line of this report?

[ Carolyn Yocom: ] The bottom line is that this is a critical program
for low-income individuals. It gives them the opportunity to have health
insurance coverage that would likely not be affordable or accessible
otherwise. However, it is also a big part of federal and state budgets,
and we have a responsibility to ensure that the money goes to where it's
most needed. We need better data and better information in order to
accomplish that.

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[ Narrator: ] To learn more, visit GAO.gov and be sure to tune in to the
next episode of GAO's Watchdog Report for more from the congressional
watchdog, the U.S. Government Accountability Office.