Medicaid (11 - 20 of 228 items)
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...
State Health Insurance Marketplaces: CMS Should Improve Oversight of State Information Technology Projects
GAO-15-527: Published: Sep 16, 2015. Publicly Released: Sep 16, 2015.
States reported to the Department of Health and Human Services' (HHS) Centers for Medicare & Medicaid Services (CMS) that they spent about $1.45 billion in federal marketplace grant funding on information technology (IT) projects supporting health insurance marketplaces, as of March 2015. The majority of this spending was for state-based marketplaces (i.e., marketplaces established and operated by...
Patient Protection and Affordable Care Act: Observations on 18 Undercover Tests of Enrollment Controls for Health-Care Coverage and Consumer Subsidies Provided under the Act
GAO-15-702T: Published: Jul 16, 2015. Publicly Released: Jul 16, 2015.
To assess the enrollment controls of the federal Health Insurance Marketplace (Marketplace), GAO performed 18 undercover tests, 12 of which focused on phone or online applications. During these tests, the Marketplace approved subsidized coverage under the Patient Protection and Affordable Care Act (PPACA) for 11 of the 12 fictitious GAO applicants for 2014. The GAO applicants obtained a total of a...
Private Health Insurance: Early Evidence Finds Premium Tax Credit Likely Contributed to Expanded Coverage, but Some Lack Access to Affordable Plans
GAO-15-312: Published: Mar 23, 2015. Publicly Released: Mar 23, 2015.
Early evidence suggests that the advance premium tax credit (APTC)—the refundable tax credit that can be paid on an advance basis—likely contributed to an expansion of health insurance coverage in 2014 because it significantly reduced the cost of exchange plans' premiums for those eligible. Although there are limitations to measuring the effects of the APTC using currently available data, surv...
Medicaid: Additional Federal Action Needed to Further Improve Third-Party Liability Efforts
GAO-15-208: Published: Jan 28, 2015. Publicly Released: Feb 10, 2015.
Based on responses to the 2012 U.S. Census Bureau's American Community Survey (ACS)—the most recent available at the time the work was conducted—GAO estimates that 7.6 million Medicaid enrollees (13.4 percent) had private health insurance in 2012. The estimated prevalence of private health insurance varied among Medicaid eligibility categories, which may differ with respect to Medicaid benefit...
Medicaid: Federal Funds Aid Eligibility IT System Changes, but Implementation Challenges Persist
GAO-15-169: Published: Dec 12, 2014. Publicly Released: Dec 12, 2014.
Reported spending across all 50 states and the District of Columbia totaled more than $1.8 billion for Medicaid 90/10 funds—funds for eligibility information technology (IT) system changes—through September 30, 2014. Spending has grown steadily, with the most significant increases over the most recent quarters. According to the Centers for Medicare & Medicaid Services (CMS), 34 states used 90/...
Children's Health Insurance: Cost, Coverage, and Access Considerations for Extending Federal Funding
GAO-15-268T: Published: Dec 3, 2014. Publicly Released: Dec 3, 2014.
Over the last 17 years, the State Children's Health Insurance Program (CHIP)—a federal-state program that provides coverage to about 8 million low-income children—has played an important role in providing health insurance coverage for children who would otherwise be uninsured. The Patient Protection and Affordable Care Act (PPACA) created alternative coverage options with the establishment of...
Private Health Insurance: Concentration of Enrollees among Individual, Small Group, and Large Group Insurers from 2010 through 2013
GAO-15-101R: Published: Dec 1, 2014. Publicly Released: Dec 1, 2014.
The Patient Protection and Affordable Care Act (PPACA) requires GAO to study competition and market concentration in the health insurance market. For this study, we examined individual, small group, and large group health insurance markets prior to the implementation of key PPACA provisions that went into effect in 2014 and that could affect competition and market concentration among health insure...
Medicaid Payment: Comparisons of Selected Services under Fee-for-Service, Managed Care, and Private Insurance
GAO-14-533: Published: Jul 15, 2014. Publicly Released: Jul 15, 2014.
Payments to physicians under Medicaid fee-for-service (FFS) and managed care for the 26 evaluation and management (E/M) services, such as office visits and emergency care, that GAO reviewed were generally lower than private insurance prior to the temporary increases mandated by the Health Care and Education Reconciliation Act of 2010 (HCERA). Specifically, in the 40 states where GAO compared Medic...