Medicaid:

Data Improvements Needed to Help Manage Health Care Program

IMTEC-93-18: Published: May 13, 1993. Publicly Released: May 13, 1993.

Additional Materials:

Contact:

Frank Reilly
(202) 512-6252
contact@gao.gov

 

Office of Public Affairs
(202) 512-4800
youngc1@gao.gov

Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) management of Medicaid data quality, focusing on whether HCFA adequately ensures that states are reporting quality data from their Medicaid information systems.

GAO found that: (1) Medicaid data are often inaccurate, incomplete, and inconsistent; (2) HCFA has not required all states to supply certain data because it does not want to impose additional reporting requirements; (3) HCFA failure to collect quality Medicaid data prevents it from conducting sound program analyses, providing comprehensive information on emerging Medicaid and health care issues, and determining if program changes are accomplishing their objectives and people are obtaining appropriate and adequate medical services under the Medicaid program; (4) HCFA does not believe the resolution of programmatic data problems is a high priority; (5) HCFA has not sufficiently reviewed the quality of Medicaid data or informed states of their inaccurate and incomplete data because it believes it would infringe on the states' rights; (6) HCFA review of states' Medicaid management information systems does not include procedures to determine if the systems contain complete and accurate data; and (7) although HCFA has implemented some improvements to its state budget reports and Medicaid budget estimating process and developed a proposal to address data problems, its actions have not been sufficient to improve the quality of program data.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: HCFA concurred, and stated that it will continue to identify data elements required for research that are not currently included in the Medicaid Statistical Information System (MSIS). Two separate workgroups are addressing required data for eligibility and covered services.

    Recommendation: The Administrator, HCFA, should identify the Medicaid data elements needed from the states to meet the nation's information needs and require the states to supply these data elements.

    Agency Affected: Department of Health and Human Services: Health Care Financing Administration

  2. Status: Closed - Implemented

    Comments: HCFA agreed to continue efforts to develop standards and measurements for quantifying data quality from states. This action is not fully responsive as it describes an existing process, not a process initiated in response to the report. GAO will close out the recommendation pending a follow-up review.

    Recommendation: The Administrator, HCFA, should develop sound data quality standards and implement a regular review of data quality as part of the systems performance review process.

    Agency Affected: Department of Health and Human Services: Health Care Financing Administration

  3. Status: Closed - Implemented

    Comments: HCFA, for MSIS states, currently gives outputs from data validation review processes. Excessive errors will cause a state's submission to be rejected and states are required to resubmit the data. However, this describes an existing process, not a new initiative, and does not address non-MSIS states. GAO will close out this recommendation pending a follow-on review.

    Recommendation: The Administrator, HCFA, should inform states of data deficiencies and enforce corrective actions to improve data quality.

    Agency Affected: Department of Health and Human Services: Health Care Financing Administration

 

Explore the full database of GAO's Open Recommendations »

Sep 29, 2016

Sep 28, 2016

Sep 15, 2016

Sep 14, 2016

Sep 12, 2016

Sep 9, 2016

Sep 6, 2016

Looking for more? Browse all our products here