Dual-eligible beneficiaries are Medicare beneficiaries who are also enrolled in the Medicaid program in their state. In certain states, they may receive both types of benefits through private managed care plans. As of January 2019, about 386,000 such individuals were enrolled in both a private Medicare plan known as a dual-eligible special needs plan (D-SNP) and a Medicaid managed care organizati

Under section 1115 of the Social Security Act, the Secretary of Health and Human Services (HHS) may approve Medicaid demonstrations to allow states to test new approaches to providing coverage and for delivering services that can transform large portions of states' programs. However, GAO found that selected states' evaluations of these demonstrations often had significant limitations that affecte

Medicaid directors earned less than most top paid managed care organization (MCO) executives in 2015 in the states GAO selected for its review. Under managed care arrangements, states contract with MCOs to provide certain services to beneficiaries. Spending for Medicaid managed care has grown significantly, representing over one-third of federal spending on Medicaid in 2014. (1) In 2015, Medicaid

GAO found that the selected states and Medicaid managed care plans face significant challenges in screening providers for eligibility to participate in the Medicaid program. Based on information we received from two selected states and 16 selected plans, GAO found that the states and plans used information that was fragmented across 22 databases managed by 15 different federal agencies to screen

Based on responses to the 2012 U.S. Census Bureau's American Community Survey (ACS)--the most recent available at the time the work was conducted--GAO estimates that 7.6 million Medicaid enrollees (13.4 percent) had private health insurance in 2012. The estimated prevalence of private health insurance varied among Medicaid eligibility categories, which may differ with respect to Medicaid benefits

MSP situations involving NGHPs are triggered by unexpected incidents, such as car accidents or work-related injuries, that involve Medicare beneficiaries and result in medical expenses for which an NGHP--rather than Medicare-- has primary responsibility for payment. In these situations, Medicare becomes a secondary payer. Medicare payments for MSP situations involving NGHPs can vary. In most MSP

Medicaid and the Children's Health Insurance Program (CHIP)--two joint federal-state health care programs for low-income families and children--play a critical role in addressing the health care needs of children. In 2008, more than 36 million children in the United States received health care coverage through Medicaid or CHIP. Like all children, children covered by Medicaid and CHIP may have hea

1) Based on GAO's survey results from 45 of the 47 premium assistance programs, 30 premium assistance programs were funded solely by Medicaid, 6 programs were funded solely by CHIP, and 9 programs were funded by both Medicaid and CHIP. 2) Twenty-five of the 37 premium assistance programs that provided eligibility information covered only low-income individuals--which the Census Bureau defines as

Our review found articles that measured the extent of concentration in private health insurance markets or focused on the relationship between competition in these markets and other variables, though the findings of these studies should be interpreted with caution. Several articles identified through our review examined the extent of concentration in private health insurance markets, though this

Sponsors, pharmacists, beneficiary advocates, and counselors GAO interviewed expressed concern that CMS's model ANOC for the 2008 AEP did not effectively communicate drug plan changes to enrollees. They noted that it contained language at a reading level too high for some beneficiaries as well as too much, often irrelevant, information. To help ensure their enrollees understood how plan changes w