Medicaid: Experience with State Waivers to Promote Cost Control and Access to Care

GAO discussed pending and approved state Medicaid waivers. GAO noted that: (1) states can request waivers of federal Medicaid requirements to facilitate projects that will further the program's objectives; (2) states generally seek waivers to expand coverage and contain costs by shifting to managed care systems; (3) since 1993, nearly half of the states have sought waivers, but only Tennessee, Oregon, Hawaii, and Rhode Island are implementing waivers; (4) as more states have sought waivers, the time between waiver submission and approval has lengthened; (5) delays in waiver implementation can occur when states request waivers before gaining state legislature approval; (6) factors that affect the success of managed care programs include the amount of time that states allow for planning and execution and the amount of effort the states devote to oversight; and (7) Oregon's managed care program is operating successfully, but Tennessee's program has encountered a number of difficulties resulting primarily from its rapid implementation.