Medicaid (91 - 100 of 1,027 items)
Indian Health Service: Most American Indians and Alaska Natives Potentially Eligible for Expanded Health Coverage, but Action Needed to Increase Enrollment
GAO-13-553: Published: Sep 5, 2013. Publicly Released: Sep 5, 2013.
GAO estimates, on the basis of recent U.S. Census Bureau data, that most American Indians and Alaska Natives will be potentially eligible for either expanded or new coverage options created by the Patient Protection and Affordable Care Act (PPACA). These options include expanded eligibility for Medicaid--the federal-state program for certain low-income individuals--and eligibility for the Health I...
Medicaid Demonstration Waivers: Approval Process Raises Cost Concerns and Lacks Transparency
GAO-13-384: Published: Jun 25, 2013. Publicly Released: Jul 18, 2013.
The 10 new demonstrations GAO examined expanded states' use of federal funds and implemented new coverage strategies. Arizona and Texas established funding pools to make new supplemental payments beyond what they could have made under traditional Medicaid requirements and receive federal matching funds for the payments. All 10 demonstrations were approved to use different coverage strategies or im...
Patient Protection and Affordable Care Act: Status of CMS Efforts to Establish Federally Facilitated Health Care Exchanges and the Federal Data Services Hub
GAO-13-786T: Published: Jul 17, 2013. Publicly Released: Jul 17, 2013.
In brief, GAO's work found that CMS will operate a health insurance exchange in the 34 states that will not operate a state-based exchange for 2014. While CMS will retain full authority over each of these 34 FFEs, it planned to allow 15 of these states to assist it in carrying out certain FFE functions. However, the activities that CMS plans to carry out in these 15 exchanges, as well as in the 17...
Patient Protection and Affordable Care Act: Status of CMS Efforts to Establish Federally Facilitated Health Insurance Exchanges
GAO-13-601: Published: Jun 19, 2013. Publicly Released: Jun 19, 2013.
The Centers for Medicare & Medicaid Services (CMS) will operate a health insurance exchange in the 34 states that will not operate a state-based exchange for 2014. Of these 34 federally facilitated exchanges (FFE), 15 are in states expected to assist CMS in carrying out certain FFE functions. However, the activities that CMS plans to carry out in these 15 exchanges, as well as in the state-based e...
Medicare: Legislative Modifications Have Resulted in Payment Adjustments for Most Hospitals
GAO-13-334: Published: Apr 17, 2013. Publicly Released: May 16, 2013.
Over time, Congress has modified how Medicare reimburses certain hospitals under the inpatient prospective payment system (IPPS), which pays hospitals a flat fee per stay, set in advance, with different amounts for each type of condition. GAO identified numerous statutory provisions that individually increased Medicare payments to a subset of hospitals.Seven provisions enabled hospitals to be paid...
Medicaid: Alternative Measures Could Be Used to Allocate Funding More Equitably
GAO-13-434: Published: May 10, 2013. Publicly Released: May 10, 2013.
GAO identified multiple data sources that could be used to develop measures to allocate Medicaid funding to states more equitably than the current funding formula--known as the Federal Medical Assistance Percentage (FMAP)--which is based solely on per capita income (PCI). To be equitable from the perspective of beneficiaries and allow states to provide a comparable level of services to each person...
CMS: Activities, Staffing, and Funding for the Center for Strategic Planning
GAO-13-377R: Published: Apr 1, 2013. Publicly Released: May 1, 2013.
CSP's activities, staff, and funding support strategic planning by individual CMS offices and centers as well as the agency itself. CMS officials told us that CSP assists individual offices and centers in developing strategic plans for their units, leads the agency's senior-level strategic planning meetings, and is helping to develop a centralized approach to monitor the implementation of CMS's ag...
Medicaid: Enhancements Needed for Improper Payments Reporting and Related Corrective Action Monitoring
GAO-13-229: Published: Mar 29, 2013. Publicly Released: May 1, 2013.
The Centers for Medicare & Medicaid Services' (CMS) methodology for estimating a national improper payment rate for the Medicaid program is statistically sound. However, CMS's procedures did not provide for updating state data used in its methodology to recognize significant corrections or adjustments after the cutoff date. The Office of Management and Budget (OMB) requires that federal agencies e...
Medicaid: Additional Enrollment and Expenditure Data for the Transitional Medical Assistance Program
GAO-13-454R: Published: Mar 15, 2013. Publicly Released: Mar 15, 2013.
Please see the report (GAO-13-454R) for the tables on Transitional Medical Assistance (TMA) enrollment and expenditures which includes states that provided additional data subsequent to our December 2012 report.Why GAO Did This StudyTransitional Medical Assistance (TMA) is a Medicaid program that offers up to 1 year of additional Medicaid health insurance benefits for certain low-income families w...
GAO's 2013 High-Risk Update: Medicare and Medicaid
GAO-13-433T: Published: Feb 27, 2013. Publicly Released: Feb 27, 2013.
Medicare Program: CMS has not met GAO's criteria to have the Medicare program removed from the High-Risk List. For example, although CMS has made progress in measuring and reducing improper payment rates in different parts of the program, it has yet to demonstrate sustained progress in lowering the rates. Because the size of Medicare relative to other programs leads to aggregate improper payments...