Medicaid (31 - 40 of 1,027 items)
Medicaid: Changes to Funding Formula Could Improve Allocation of Funds to States
GAO-16-377T: Published: Feb 10, 2016. Publicly Released: Feb 10, 2016.
In prior work, GAO identified alternative measures that could be used to allocate Medicaid funding to states more equitably than the current Federal Medical Assistance Percentage (FMAP) formula, which uses per capita income (PCI) to calculate each state's federal matching rate. GAO found that PCI is a poor proxy for both the size of a state's population in need of Medicaid services and the ability...
Medicaid Managed Care: Trends in Federal Spending and State Oversight of Costs and Enrollment
GAO-16-77: Published: Dec 17, 2015. Publicly Released: Jan 19, 2016.
Federal spending for Medicaid managed care increased significantly from fiscal year 2004 through fiscal year 2014 (from $27 billion to $107 billion), and represented 38 percent of total federal Medicaid spending in fiscal year 2014. Consistent with this national trend, managed care as a proportion of total federal Medicaid spending was higher in seven of eight selected states in fiscal year 2014 c...
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...
Medicaid Financing: Questionnaire Data on States' Methods for Financing Medicaid Payments from 2008 through 2012 (GAO-15-227SP, March 2015), an E-supplement to GAO-14-627 [Reissued on December 7, 2015]
GAO-15-227SP: Published: Mar 13, 2015. Publicly Released: Mar 13, 2015.
This e-publication supplements our report, GAO-14-627, by presenting comprehensive results of a GAO web-based questionnaire on state methods for financing Medicaid payments, which was fielded to all 50 states and the District of Columbia between July 2013 and November 2013.The questionnaire collected information on states' use of seven different sources of funds to finance the nonfederal share of...
Medicaid: Improving Transparency and Accountability of Supplemental Payments and State Financing Methods
GAO-16-195T: Published: Nov 3, 2015. Publicly Released: Nov 3, 2015.
GAO has found that complete and reliable data are lacking on the tens of billions in Medicaid supplemental payments states often make, hindering transparency and oversight. In a November 2012 report, GAO found that Congress and the Centers for Medicare & Medicaid Services (CMS) have acted to improve transparency and accountability for one type of Medicaid supplemental payment known as disproportio...
Medicaid: Additional Efforts Needed to Ensure that State Spending is Appropriately Matched with Federal Funds
GAO-16-53: Published: Oct 16, 2015. Publicly Released: Oct 23, 2015.
PPACA-expansion and state-expansion enrollees—individuals who were not eligible under historic Medicaid eligibility rules but are eligible under (1) a state option to expand Medicaid under the Patient Protection and Affordable Care Act (PPACA), or (2) a state's qualifying expansion of coverage prior to PPACA's enactment—comprised about 14 percent of Medicaid enrollees and about 10 percent of M...
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,...
Medicaid: Additional Federal Controls Needed to Improve Accuracy of Eligibility Determinations and for Coordination with Exchanges
GAO-16-157T: Published: Oct 23, 2015. Publicly Released: Oct 22, 2015.
Beginning in 2014, the Patient Protection and Affordable Care Act (PPACA) provided millions of low-income Americans new options for obtaining health insurance coverage—through the Medicaid program or by purchasing private health insurance through an exchange. Although the Centers for Medicare & Medicaid Services (CMS) has taken some steps, GAO identified gaps in its oversight of Medicaid enrollm...
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...
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...