Medicaid (1 - 10 of 270 items)
Private Health Insurance: In Most States and New Exchanges, Enrollees Continued to be Concentrated among Few Issuers in 2014 [Reissued on February 14, 2017]
GAO-16-724: Published: Sep 6, 2016. Publicly Released: Sep 6, 2016.
GAO found that enrollment in private health insurance plans remained concentrated among a small number of issuers in most states in 2014, including in the newly established exchanges. On average in each state and the District of Columbia, 11 or more issuers participated in each of three types of markets—individual, small group, and large group—from 2011 through 2014. However, in most states, t...
Foster Care: HHS Has Taken Steps to Support States' Oversight of Psychotropic Medications, but Additional Assistance Could Further Collaboration
GAO-17-129: Published: Jan 5, 2017. Publicly Released: Feb 6, 2017.
State child welfare and Medicaid officials in seven selected states reported a variety of practices to support the appropriate use of psychotropic medications, which affect mood, thought, or behavior, for children in foster care. Practices include screening for mental health conditions, developing prescription guidelines, and monitoring a child's health while on medication. Additional state effort...
Hospital Uncompensated Care: Federal Action Needed to Better Align Payments with Costs
GAO-16-568: Published: Jun 30, 2016. Publicly Released: Aug 1, 2016.
Key sources of federal support for hospitals incurring costs for services provided to uninsured and other low-income individuals (uncompensated care costs) include multiple types of Medicaid and Medicare payments totaling about $50 billion annually. GAO's analysis shows that through Medicaid, a joint federal-state program for low-income individuals, states made three types of payments that helped...
Federal Autism Activities: Agencies Are Encouraging Early Identification and Providing Services, and Recent Actions Could Improve Coordination
GAO-16-446: Published: May 20, 2016. Publicly Released: Jun 20, 2016.
Federal agencies have taken various actions to encourage early autism identification and interventions, such as specifically soliciting research in these areas. From fiscal year 2012 through fiscal year 2015, the departments of Defense (DOD), Education, and Health and Human Services (HHS), awarded about $395 million for research on early identification and interventions for autism.Federal programs...
Medicare Advantage: Action Needed to Ensure Appropriate Payments for Veterans and Nonveterans
GAO-16-137: Published: Apr 11, 2016. Publicly Released: May 11, 2016.
In fiscal year 2010, the Department of Veterans Affairs (VA) health care system provided $2.4 billion in inpatient and outpatient services to the 833,684 veterans enrolled in Medicare Advantage (MA), a private plan alternative to Medicare fee-for-service (FFS). While the Centers for Medicare & Medicaid Services (CMS), an agency within the Department of Health and Human Services (HHS), generally pa...
Nonemergency Medical Transportation: Updated Medicaid Guidance Could Help States
GAO-16-238: Published: Feb 2, 2016. Publicly Released: Mar 3, 2016.
The nonemergency medical transportation (NEMT) benefits offered by Medicare and Medicaid differ. Medicare provides NEMT via ambulance only when other means of transportation, such as a taxi or wheelchair van, would jeopardize the health of the beneficiary. Medicaid NEMT is generally available for beneficiaries who have no other means of transportation to medical services. States are responsible fo...
Medicare and Medicaid: Additional Oversight Needed of CMS's Demonstration to Coordinate the Care of Dual-Eligible Beneficiaries
GAO-16-31: Published: Dec 18, 2015. Publicly Released: Jan 19, 2016.
Due to the flexibility that states have in designing their Financial Alignment Demonstrations, the integrated care organizations that GAO interviewed in California, Illinois, Massachusetts, Virginia, and Washington implemented care coordination for dual-eligible Medicare and Medicaid beneficiaries in a variety of ways. For example, these organizations assigned care coordinators to beneficiaries us...
Medicare Advantage: Actions Needed to Enhance CMS Oversight of Provider Network Adequacy
GAO-15-710: Published: Aug 31, 2015. Publicly Released: Sep 28, 2015.
The Centers for Medicare & Medicaid Services (CMS) is the agency within the Department of Health and Human Services (HHS) responsible for overseeing the Medicare Advantage (MA) program—Medicare's private plan alternative. Since 2011, CMS has defined an adequate MA provider network as meeting two criteria: a minimum number of providers and maximum travel time and distance to those providers. To r...
Behavioral Health: Options for Low-Income Adults to Receive Treatment in Selected States
GAO-15-449: Published: Jun 19, 2015. Publicly Released: Jul 20, 2015.
Nationwide, estimates using 2008-2013 data indicated that approximately 17 percent of low-income, uninsured adults (3 million) had a behavioral health condition, defined as a serious mental illness, a substance use condition, or both. Underlying these national estimates is considerable variation at the state level.Estimated Percentage of Low-Income, Uninsured Adults with Behavioral Health Conditio...
Medicare: Results from the First Two Years of the Pioneer Accountable Care Organization Model
GAO-15-401: Published: Apr 22, 2015. Publicly Released: May 22, 2015.
Health care providers and suppliers voluntarily form accountable care organizations (ACO) to provide coordinated care to patients with the goal of reducing spending while improving quality. Within the Centers for Medicare & Medicaid Services (CMS), the Center for Medicare & Medicaid Innovation (CMMI) began testing the Pioneer ACO Model in 2012. Under this model, ACOs can earn additional Medicare p...