Health care programs (1 - 10 of 195 items)
Medicaid: Key Policy and Data Considerations for Designing a Per Capita Cap on Federal Funding
GAO-16-726: Published: Aug 10, 2016. Publicly Released: Sep 9, 2016.
Through review of its prior reports, the literature and interviews with state Medicaid officials and subject matter experts, GAO identified several key interrelated policy considerations that could be useful should policymakers elect to pursue a per capita cap—a per-enrollee limit on federal Medicaid funding for states.Coverage and flexibility. Coverage entails decisions about whether all or a s...
Medicare Part B: Data on Coupon Discounts Needed to Evaluate Methodology for Setting Drug Payment Rates
GAO-16-643: Published: Jul 27, 2016. Publicly Released: Aug 26, 2016.
In 2015, manufacturers of 29 of the 50 high-expenditure Medicare Part B drugs GAO analyzed offered coupon programs, which reduce the costs patients incur for specific drugs. Part B drugs are typically administered by a physician. Coupon programs are prohibited in the Medicare program but are generally available to privately insured patients. GAO obtained data on coupon discounts for 18 drugs. GAO...
Immigration Detention: Additional Actions Needed to Strengthen Management and Oversight of Detainee Medical Care
GAO-16-231: Published: Feb 29, 2016. Publicly Released: Feb 29, 2016.
The Department of Homeland Security's (DHS) U.S. Immigration and Customs Enforcement (ICE) oversees basic on-site medical care at all facilities, as required by ICE detention standards, but does not maintain complete information about medical care costs. The ICE Health Service Corps (IHSC) provided direct care to detainees at 19 over-72-hour facilities and oversaw care at the remaining 146 non-IHS...
VA Health Care: Actions Needed to Improve Monitoring and Oversight of Non-VA and Contract Care
GAO-15-654T: Published: Jun 1, 2015. Publicly Released: Jun 1, 2015.
GAO's recent work has found significant weaknesses in the Department of Veterans Affairs' (VA) monitoring and oversight of its Non-VA Medical Care Program. Through this program, care is provided to veterans by non-VA providers in non-VA facilities. As GAO reported in May 2013, VA did not collect data on wait times veterans face in obtaining care from non-VA providers. Having data on wait times for...
Medicaid: A Small Share of Enrollees Consistently Accounted for a Large Share of Expenditures
GAO-15-460: Published: May 8, 2015. Publicly Released: May 8, 2015.
A small percentage of Medicaid-only enrollees—that is, those who were not also eligible for Medicare—consistently accounted for a large percentage of total Medicaid expenditures for Medicaid-only enrollees. In each fiscal year from 2009 through 2011, the most expensive 5 percent of Medicaid-only enrollees accounted for almost half of the expenditures for all Medicaid-only enrollees. In contras...
Children's Health Insurance Program: Effects on Coverage and Access, and Considerations for Extending Funding
GAO-15-348: Published: Feb 27, 2015. Publicly Released: Mar 30, 2015.
Assessments of national data GAO reviewed identify positive effects of the State Children's Health Insurance Program (CHIP), and the quality measures reported by states help identify areas needing improvement.A mandated evaluation of CHIP published in 2014 noted that CHIP enrollees (1) had substantially better access to care, service use, and preventive care when compared with uninsured children;...
Medicaid Financing: States' Increased Reliance on Funds from Health Care Providers and Local Governments Warrants Improved CMS Data Collection [Reissued on March 13, 2015]
GAO-14-627: Published: Jul 29, 2014. Publicly Released: Jul 29, 2014.
GAO found, based on a questionnaire sent to state Medicaid agencies, that states financed 26 percent, or over $46 billion, of the nonfederal share of Medicaid expenditures with funds from health care providers and local governments in state fiscal year 2012. State funds were most of the remaining nonfederal share.Nationally, states increasingly relied on funds from providers and local governments...
Improper Payments: TRICARE Measurement and Reduction Efforts Could Benefit from Adopting Medical Record Reviews
GAO-15-269: Published: Feb 18, 2015. Publicly Released: Feb 18, 2015.
The Defense Health Agency (DHA), the agency within the Department of Defense (DOD) responsible for administering the military health program known as TRICARE, uses a methodology for measuring TRICARE improper payments that is less comprehensive than the methodology used to measure improper payments in Medicare, the federal health care program for the elderly and certain disabled individuals. Both...
Disabled Dual-Eligible Beneficiaries: Integration of Medicare and Medicaid Benefits May Not Lead to Expected Medicare Savings
GAO-14-523: Published: Aug 29, 2014. Publicly Released: Sep 29, 2014.
Overall spending for high-expenditure disabled dual-eligible beneficiaries—those in the top 20 percent of spending in their respective states—was driven largely by Medicaid spending, and the service use and health status often differed widely between those with high Medicare expenditures and high Medicaid expenditures. For these beneficiaries, Medicaid expenditures accounted for nearly two-thi...
Health Resources and Services Administration: Action Taken to Train and Oversee Grantee Monitoring Staff, but Certain Guidance Could Be Improved
GAO-14-800: Published: Sep 23, 2014. Publicly Released: Sep 23, 2014.
In 2012, the Department of Health and Human Services' (HHS) Health Resources and Services Administration (HRSA) began systematically developing guidance for the key staff involved in grantee monitoring—project officers in its programmatic bureaus and grants management specialists and financial integrity staff in its Office of Federal Assistance Management (OFAM). Specifically, HRSA issued the fi...