From the U.S. Government Accountability Office, www.gao.gov Transcript for: Unlocking Medicaid: Key Oversight Issues Description: GAO work highlights the need for better Medicaid information to ensure that beneficiaries can access health care services and that program spending is appropriate. Related GAO Works: GAO-20-8: Medicaid Providers: CMS Oversight Should Ensure State Implementation of Screening and Enrollment Requirements Released: November 2019 [ Background Music ] Medicaid and Medicare have similar names but are very different. [ The words "Medicare" and "Medicaid" appear on the screen ] Medicaid is a federal and state program that provides health coverage for people who may not otherwise be able to afford it. [ Graphics help explain the definition of Medicaid. ] In 2020, Medicaid is projected to cover over 75 million people at a cost of about $700 billion. Total program spending is projected to hit $1 trillion by 2026. [ These statistics show up on the screen to show the growth of cost and population. ] Unlike Medicare beneficiaries, who are typically 65 or older, [ Graphics are used to explain Medicare ] Medicaid beneficiaries can be any age and include people with disabilities and families with children who meet income and other eligibility requirements. [ The following statistics are graphically displayed on the screen ] In fact, about 40 percent of Medicaid beneficiaries are 18 or younger. Did you know that nearly half of all births in the country are covered by Medicaid? At the other end of the age spectrum, Medicaid pays for the care of most nursing home residents. An increasing number of people are expected to rely on nursing homes and other services for older adults as the American population continues to age. [ Covers of GAO reports on Medicaid are laid across the screen ] In this video, we're looking at GAO's work on Medicaid. Each state's Medicaid program is different because states have flexibility to design their programs to meet their own needs. That's part of why program monitoring is so important and complicated. [ Graphics including magnifying glass, folder, binary code, and a cloud are all used to depict data ]. Good information, that is, data is key to program oversight. However, available Medicaid data haven't always shed light on how well the Medicaid program is operating. We've done extensive work on Medicaid oversight. Let's take a look at four of our findings. [ A poker pin wheel and poker chip appear to show who gets money from Medicaid ] First, sometimes payments go to physicians, hospitals, and other healthcare providers who aren't eligible, either by mistake or because of fraud. [ A map of the U.S. appears and the words "Higher Program Cost" and "Fewer Resources Available" appear over the map. ] States and the federal government haven't always been able to prevent them, leading to higher program costs and fewer resources available to help people. [ Graphics appear to depict oversight ] Better oversight could provide the information needed to prevent payments to healthcare providers who have suspended or revoked medical licenses, invalid addresses, or false identities. [ Graphics show payments going to hospitals from Medicaid ] The second issue is about tracking certain Medicaid payments to hospitals. These payments can help hospitals cover costs, but without good data on them, it's hard to know whether the money is targeted to the right hospitals, or that the amounts are appropriate. If payments exceed legal limits, Medicaid can take steps to recoup the money. [ Cartoon people in a doctor's office appear in a magnifying glass ] Third, we also found difficulty ensuring that Medicaid's beneficiaries are receiving the services they need. For example, states and the federal government don't always know whether children covered by Medicaid receive regular well-child visits, or are able to see specialists, such as dentists, when they've been referred. If doctors and specialists catch health problems early, it can save lives and better target spending. [ Cartoon people are sorted into different boxes that represent different types of medical care such as dentist, hospital, and nursing home ] Fourth, better information on beneficiary access and use of services can help Medicaid identify coverage gaps and take steps to make sure people get the care they need as soon as possible. What's being done to get better Medicaid information? Well, we've made a number of recommendations over the years. [ U.S. Capitol and the U.S. Map show up on the screen and the words "Centers for Medicaid and Medicare Services" appear below ] Also, states and the federal government have some promising efforts underway. For example, the Centers for Medicare and Medicaid Services has made positive strides by creating a new data system to collect information from states on providers and beneficiaries. [ Graphics show data going into cogs ] All states are now submitting some data to the system and work is underway to create processes for checking the data and using it for oversight. Having good Medicaid information will require a long-term commitment. [ Map of U.S. appears on the screen with the word "Medicaid" in the middle of it ] Medicaid helps millions of Americans but is on an unsustainable fiscal path. [ GAO Logo appears on the screen ] We will continue to highlight the importance of good information for good oversight in managing the Medicaid program. Learn more about Medicaid oversight at gao.gov.