Health insurance (11 - 20 of 664 items)
Patient Protection and Affordable Care Act: Information on Approval Process for State Innovation Waivers
GAO-16-637R: Published: Jul 6, 2016. Publicly Released: Aug 5, 2016.
The Departments of Health and Human Services (HHS) and Treasury (Treasury; referred to together as the Departments) have established a number of controls in their process for approving state proposals to waive certain provisions of the Patient Protection and Affordable Care Act (PPACA), referred to as 1332 waivers. These controls seek to ensure that approved waivers meet the statutory criteria of...
Medicaid Program Integrity: Improved Guidance Needed to Better Support Efforts to Screen Managed Care Providers
GAO-16-402: Published: Apr 22, 2016. Publicly Released: May 6, 2016.
GAO found that the selected states and Medicaid managed care plans face significant challenges in screening providers for eligibility to participate in the Medicaid program. Based on information we received from two selected states and 16 selected plans, GAO found that the states and plans used information that was fragmented across 22 databases managed by 15 different federal agencies to screen p...
Healthcare.gov: Actions Needed to Enhance Information Security and Privacy Controls
GAO-16-265: Published: Mar 23, 2016. Publicly Released: Mar 23, 2016.
The Centers for Medicare & Medicaid Services (CMS) reported 316 security-related incidents, between October 2013 and March 2015, affecting Healthcare.gov—the web portal for the federal health insurance marketplace—and its supporting systems. According to GAO's review of CMS records for this period, the majority of these incidents involved such things as electronic probing of CMS systems by pot...
Small Employer Health Tax Credit: Limited Use Continues Due to Multiple Reasons
GAO-16-491T: Published: Mar 22, 2016. Publicly Released: Mar 22, 2016.
Claims of the small employer health tax credit have continued to be lower than thought eligible by government agency and small business group estimates, limiting the effect of the credit on expanding health insurance coverage through small employers. In 2014, about 181,000 employers claimed the credit, down somewhat from 2010 (see figure). These numbers are relatively low compared to the number of...
Private Health Insurance: Federal Oversight Premiums and Enrollment for Consumer Operated and Oriented Plans in 2015
GAO-16-326: Published: Mar 10, 2016. Publicly Released: Mar 17, 2016.
The Centers for Medicare & Medicaid Services' (CMS) monitoring of the consumer governed, nonprofit health insurance issuers—known as consumer operated and oriented plans (CO-OPs)—evolved as the CO-OP program matured, and as 12 of the 23 CO-OPs ceased operations on or before January 1, 2016. CMS's initial monitoring activities, starting when it began to award CO-OP program loans in early 2012,...
Patient Protection and Affordable Care Act: CMS Should Act to Strengthen Enrollment Controls and Manage Fraud Risk
GAO-16-29: Published: Feb 23, 2016. Publicly Released: Feb 24, 2016.
The Patient Protection and Affordable Care Act (PPACA) requires applicant information be verified to determine eligibility for enrollment or income-based subsidies. To implement this verification process, the Centers for Medicare & Medicaid Services (CMS) created an electronic system called the “data services hub” (data hub), which, among other things, provides a single link to federal sources...
Unaccompanied Children: HHS Can Improve Monitoring of Their Care
GAO-16-429T: Published: Feb 23, 2016. Publicly Released: Feb 23, 2016.
In fiscal year 2014, nearly 57,500 children traveling without their parents or guardians (referred to as unaccompanied children) were apprehended and transferred to the care of the Department of Health and Human Services' Office of Refugee Resettlement (ORR). Most of these children were from Central America. GAO found that ORR was initially unprepared to care for that many children; however, the a...
Unaccompanied Children: HHS Can Take Further Actions to Monitor Their Care
GAO-16-180: Published: Feb 5, 2016. Publicly Released: Feb 22, 2016.
In fiscal year 2014, nearly 57,500 children traveling without their parents or guardians (referred to as unaccompanied children) were apprehended by federal immigration officers and transferred to the care of the Department of Health and Human Services' Office of Refugee Resettlement (ORR). Most of these children were from Central America. GAO found that ORR was initially unprepared to care for th...
Medicaid and Insurance Exchanges: Additional Federal Controls Needed to Minimize Potential for Gaps and Duplication in Coverage
GAO-16-73: Published: Oct 9, 2015. Publicly Released: Oct 23, 2015.
CMS's policies and procedures do not sufficiently minimize the potential for coverage gaps and duplicate coverage in federal exchange states. GAO found that individuals transitioning from Medicaid to exchange coverage—that is, private health insurance purchased through the exchanges created under the Patient Protection and Affordable Care Act (PPACA)—may experience coverage gaps, for example,...
Patient Protection and Affordable Care Act: Preliminary Results of Undercover Testing of the Federal Marketplace and Selected State Marketplaces for Coverage Year 2015
GAO-16-159T: Published: Oct 23, 2015. Publicly Released: Oct 22, 2015.
Under the Patient Protection and Affordable Care Act (PPACA), health-insurance marketplaces are required to verify application information to determine eligibility for enrollment and, if applicable, determine eligibility for income-based subsidies or Medicaid. These verification steps include reviewing and validating information about an applicant's Social Security number, if one is provided; citi...