State-administered programs (11 - 20 of 137 items)
State Children's Health Insurance Program: CMS Should Improve Efforts to Assess whether SCHIP Is Substituting for Private Insurance
GAO-09-252: Published: Feb 20, 2009. Publicly Released: Mar 23, 2009.
Congress created the State Children's Health Insurance Program (SCHIP) to reduce the number of uninsured children in low-income families that do not qualify for Medicaid. States have flexibility in structuring their SCHIP programs, and their income eligibility limits vary. Concerns have been raised that individuals might substitute SCHIP for private health insurance--known as crowd-out. GAO was as...
Medicaid Financing: Long-standing Concerns about Inappropriate State Arrangements Support Need for Improved Federal Oversight
GAO-08-650T: Published: Apr 3, 2008. Publicly Released: Apr 3, 2008.
Medicaid, a joint federal-state program, financed the health care for about 59 million low-income people in fiscal year 2006. States have considerable flexibility in deciding what medical services and individuals to cover and the amount to pay providers, and the federal government reimburses a portion of states' expenditures according to a formula established by law. The Centers for Medicare & Med...
Medicaid Demonstration Waivers: Lack of Opportunity for Public Input during Federal Approval Process Still a Concern
GAO-07-694R: Published: Jul 24, 2007. Publicly Released: Aug 23, 2007.
States provide health care coverage to about 60 million low-income individuals through Medicaid, a joint federal and state program established under title XIX of the Social Security Act (the Act). Title XIX of the Act established parameters under which states operate their Medicaid programs, such as requiring states to cover certain services for certain mandatory groups of individuals such as low-...
Medicaid: Concerns Remain about Sufficiency of Data for Oversight of Children's Dental Services
GAO-07-826T: Published: May 2, 2007. Publicly Released: May 2, 2007.
The 31 million children enrolled in Medicaid are particularly vulnerable to tooth decay, which, if untreated, may lead to more serious health conditions and, on rare occasion, result in death. Congress established a comprehensive health benefit for children enrolled in Medicaid to cover Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, which include dental services. The Cen...
Children's Health Insurance: States' SCHIP Enrollment and Spending Experiences and Considerations for Reauthorization
GAO-07-558T: Published: Mar 1, 2007. Publicly Released: Mar 1, 2007.
In August 1997, Congress created the State Children's Health Insurance Program (SCHIP) with the goal of significantly reducing the number of low-income uninsured children, especially those who lived in families with incomes exceeding Medicaid eligibility requirements. Unlike Medicaid, SCHIP is not an entitlement to services for beneficiaries but a capped allotment to states. Congress provided a fi...
Children's Health Insurance: Recent HHS-OIG Reviews Inform the Congress on Improper Enrollment and Reductions in Low-Income, Uninsured Children
GAO-06-457R: Published: Mar 9, 2006. Publicly Released: Mar 9, 2006.
The Congress passed legislation creating the State Children's Health Insurance Program (SCHIP) in 1997 to reduce the number of uninsured children in families with incomes that are too high to qualify for Medicaid. For SCHIP, the Congress appropriated $40 billion over 10 years, with funds allotted annually to the 50 states, the District of Columbia, and the U.S. commonwealths and territories. State...
Influenza Pandemic: Challenges in Preparedness and Response
GAO-05-863T: Published: Jun 30, 2005. Publicly Released: Jun 30, 2005.
Shortages of influenza vaccine in the 2004-05 and previous influenza seasons and mounting concern about recent avian influenza activity in Asia have raised concern about the nation's preparedness to deal with a worldwide influenza epidemic, or influenza pandemic. Although the extent of such a pandemic cannot be predicted, according to the Centers for Disease Control and Prevention (CDC), an agency...
Medicaid: States' Efforts to Maximize Federal Reimbursements Highlight Need for Improved Federal Oversight
GAO-05-836T: Published: Jun 28, 2005. Publicly Released: Jun 28, 2005.
Medicaid--the federal-state health care financing program covering almost 54 million low-income people at a cost of $276 billion in fiscal year 2003--is by its size and structure at significant risk of waste and exploitation. Because of challenges inherent in overseeing the program, which is administered federally by the Centers for Medicare & Medicaid Services (CMS), GAO added Medicaid to its lis...
Health Centers And Rural Clinics: State and Federal Implementation Issues for Medicaid's New Payment System
GAO-05-452: Published: Jun 17, 2005. Publicly Released: Jun 17, 2005.
The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) established a prospective payment system (PPS) for Medicaid payments to Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC), giving providers a financial incentive to operate efficiently. BIPA requires that BIPA PPS rates be adjusted for inflation and changes in scope of services. States a...
Medicaid Waivers: HHS Approvals of Pharmacy Plus Demonstrations Continue to Raise Cost and Oversight Concerns
GAO-04-480: Published: Jun 30, 2004. Publicly Released: Jul 30, 2004.
Under section 1115 of the Social Security Act, the Secretary of Health and Human Services may waive certain Medicaid requirements for states seeking to deliver services through demonstration projects. By policy, these demonstrations must not increase federal spending. GAO has previously reported concerns with HHS's approval process. GAO was asked to provide information on a new Medicaid section 11...