Medicaid spending is projected to hit $1 trillion by 2026. Studies have found a small percentage of beneficiaries account for a large amount of its spending. Many high-cost beneficiaries have poorly managed chronic conditions that can result in costly services—such as emergency room visits—that are preventable. We asked officials in 7 states what they do to manage health care costs and improv...

Not taking medications as prescribed can increase the risk of medical complications and costs. According to pharmacy groups, synchronizing medication refills can make it easier for patients to get their medications and thus promote taking them as prescribed. Pharmacists could realign refill dates for all of a patient's medications so they may be picked up together. We found no comprehensive infor...

The Zika virus appeared in the Western Hemisphere in May 2015 and spread to many countries in less than a year. Zika can have mild or unnoticed symptoms, but it can also cause severe birth defects. In response, USAID supported a range of activities overseas, including mosquito control, public awareness, and research. However, USAID didn't track Zika funding by country and took longer than desired...

An air ambulance can quickly transport you to a hospital in an emergency. But how much could it cost you? The data we reviewed indicated that in 2017, about 2/3 of air ambulance transports for patients with private insurance were out-of-network. Generally, insurance only pays for a portion of an out-of-network service. In that case, you could be billed for the difference between what the air amb...

Federal spending on health care—driven primarily by Medicare and Medicaid—is expected to top $1 trillion in 2018. The Affordable Care Act created the CMS Innovation Center to test new approaches to health care delivery, known as models, that could curb spending while providing better care. We reviewed the center's efforts. Since 2010, the center has tested or is in the process of testing 37...

Under the Affordable Care Act, people purchasing insurance through an exchange can re-enroll each year. If they don't select a plan, they're automatically re-enrolled in their existing plan or a similar one, if available. In 2016, 30% of re-enrollments were automatic. We examined whether automatic re-enrollment could have unintended financial consequences for consumers. We found that, from 2015 t...

Starting in 2020, the Affordable Care Act is scheduled to impose a 40% tax on high-cost health plans when an employee's annual cost of coverage exceeds a certain dollar limit. The limit may be adjusted if an employer's workforce—based on age and gender—is likely to have higher than average health costs. The adjustment is to be made based on the costs of the federal employee BlueCross BlueShie...

In fiscal year 2016, the Department of Health and Human Services' (HHS) Centers for Medicare & Medicaid Services (CMS) assessed its advance premium tax credit (PTC) program as susceptible to significant improper payments. CMS instituted a qualitative method for assessing the susceptibility of its program that was consistent with requirements, including assessing each of the nine required qualitati...

From fiscal years 2009 through 2016, the Bureau of Prisons (BOP) obligated more than $9 billion for the provision of inmate health care and several factors affected these costs. Obligations for health care rose from $978 million in fiscal year 2009 to $1.34 billion in fiscal year 2016, an increase of about 37 percent. On a per capita basis, and adjusting for inflation, health care obligations rose...

Through review of its prior reports, the literature and interviews with state Medicaid officials and subject matter experts, GAO identified several key interrelated policy considerations that could be useful should policymakers elect to pursue a per capita cap—a per-enrollee limit on federal Medicaid funding for states.Coverage and flexibility. Coverage entails decisions about whether all or a s...