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Highlights

Pursuant to a congressional request, GAO provided information on the decline in Medicaid enrollment, focusing on: (1) Medicaid enrollment changes for families and children following welfare reform, as well as associated key federal protections established for Medicaid; and (2) states' welfare-related policies and practices that can influence Medicaid enrollment.

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Recommendations

Matter for Congressional Consideration

Matter Status Comments
To further facilitate families' making the transition from welfare to work and to prevent income-eligible families from being terminated from Medicaid for procedural reasons, Congress should consider revising section 1925 of the Social Security Act. Specifically, Congress may wish to allow states to lessen or eliminate periodic income reporting requirements for families receiving transitional Medicaid coverage, provided that states offer adequate assurances that the benefits are reserved for those who are eligible. Actions in this regard could facilitate uninterrupted health insurance coverage for families that are moving from cash assistance to the workforce.
Closed - Not Implemented
Legislation has been proposed several times by members of Congress but has not been enacted.

Recommendations for Executive Action

Agency Affected Recommendation Status
Health Care Financing Administration 1. In order to ensure that eligible individuals leaving cash assistance do not lose Medicaid coverage, the Administrator, HCFA, should determine the extent to which transitional Medicaid is reaching the eligible population.
Closed - Implemented
CMS is about to issue a final report on its 50-state review of the delinking of Medicaid and TANF in the states. As part of these on-site reviews, CMS reviewed state compliance with CMS on the provision of transitional Medicaid. While the report notes compliance or barrier problems with the provision of transitional Medicaid, it does not determine the extent to which transitional Medicaid is reaching the eligible population.
Health Care Financing Administration 2. In order to ensure that eligible individuals leaving cash assistance do not lose Medicaid coverage, the Administrator, HCFA, should provide states with guidance or other appropriate technical assistance regarding best approaches for implementing transitional Medicaid in a manner that facilitates the full and appropriate use of this entitlement for eligible beneficiaries.
Closed - Implemented
In July 2000, HCFA reported that they began a year-long series of training for all states and HCFA regional offices on a wide array of Medicaid eligibility issues. In August 2000, it provided further policy clarification and discussed eligibility issues with states and its regional offices at the National Eligibility Conference. While HCFA did not release the final report, CMS reported to GAO that it is about to issue final reports on its 50-state review of the delinking of Medicaid and TANF in the states. As part of these reviews, CMS reviewed state compliance with CMS guidance on the provision of transitional Medicaid by reviewing state guidance, and discussing compliance with state officials, local caseworkers, and local advocacy groups. CMS reported that they identified compliance and barriers problems with the provision of transitional Medicaid. Additionally, CMS stated that it reports on states' actions, as well as CMS requested actions necessary to address these barriers.

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