Medicaid Financing: Questionnaire Data on States' Methods for Financing Medicaid Payments from 2008 through 2012 (GAO-15-227SP, March 2015), an E-supplement to GAO-14-627

Read the Full Report: Medicaid Financing: States' Increased Reliance on Funds from Health Care Providers and Local Governments Warrants Improved CMS Data Collection (GAO-14-627).


This e-publication supplements our report, GAO-14-627, by presenting comprehensive results of a GAO web-based questionnaire on state methods for financing Medicaid payments, which was fielded to all 50 states and the District of Columbia between July 2013 and November 2013.

The questionnaire collected information on states' use of seven different sources of funds to finance the nonfederal share of Medicaid expenditures for state fiscal years 2008 through 2012: state general funds, state intra-agency transfer of funds, health care provider taxes, health care provider donations, intergovernmental transfers from local governments, certification of Medicaid expenditures by local governments, and other sources. Specifically, the questionnaire collected information on states' use of these sources of funds to finance the nonfederal share for four types of Medicaid payments: (1) fee-for-service Medicaid payments, (2) capitation payments to managed care organizations, (3) Medicaid Disproportionate Share Hospital supplemental payments, and (4) Medicaid Non-Disproportionate Share Hospital supplemental payments and other Medicaid payments. In addition, the questionnaire collected information on health care provider taxes, including the types of provider taxes each state levied, the ways in which the taxes were levied, and the uses of the revenue collected from the taxes. In providing us with funding data, states were asked to exclude funds used to pay for the nonfederal share of state Medicaid administrative expenses and the nonfederal share of state Medicaid payments that were appropriated or collected, but not expended.

All states responded to the questionnaire, and the questionnaire responses were not subject to sampling error. We reviewed the reported data for nonsampling errors, for example, instances where respondents provided conflicting, vague, or incomplete information. We generally addressed these errors by contacting the state Medicaid department officials involved and clarifying their responses. We did not independently verify the data reported by states in the questionnaire; however, we reviewed published data submitted by state Medicaid programs to the Centers for Medicare & Medicaid Services and to outside researchers to assess the reasonableness of the data reported. We believe that the questionnaire data were reliable for our purposes. Assessing whether states were compliant with federal requirements related to nonfederal sources of funds for Medicaid payments was not within the scope of this review.

We conducted the performance audit for our full report on state Medicaid financing sources (GAO-14-627) in accordance with generally accepted government auditing standards. We adhered to these standards by planning and performing the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions based on our audit objectives. We believe that the evidence obtained provides a reasonable basis for our findings and conclusions based on our audit objectives for our report and this supplement.


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The e-supplement was revised 12/07/2015 to correct column headers in section G4. The corrected header reads: "Number of health care provider taxes levied as a percentage of net patient service revenues".