GAO Issues Report on Medicaid Demonstrations
The report was sent to Sen.
What GAO Found: "Medicaid demonstrations allow states flexibility to test new approaches for providing coverage and delivering Medicaid services. Since 2012, the
However, GAO found weaknesses in CMS's policies for ensuring transparency.
* Changes to pending applications for new demonstrations or extensions. CMS lacks policies for ensuring transparency when states submit major changes to pending applications. For two of the four approvals of new demonstrations or extensions GAO reviewed in-depth, states submitted changes to their applications that could have significant effects on beneficiaries (such as disenrollment or other penalties) without first obtaining public comment on these changes at the state level.
* Amendments to existing demonstrations. CMS's transparency requirements for amendments are limited. For example, CMS does not require amendment applications to include how the changes may affect beneficiary enrollment or report on concerns raised in state public comments. However, states have proposed major changes--such as work and community engagement requirements--through amendments, raising concerns that major changes to states' demonstrations are being approved without a complete understanding of their impact."
Why GAO Did This Study: "Section 1115 demonstrations are a significant component of Medicaid spending and affect the care of millions of beneficiaries. The Patient Protection and Affordable Care Act required the
GAO was asked to examine the transparency of demonstration approvals. Among other things, this report examines CMS's transparency policies and procedures for new demonstrations and extensions, and amendments to existing demonstrations. To review a variety of approval types across a large number of states, GAO examined all approvals of new demonstrations and extensions of and amendments to existing demonstrations granted from
What GAO Recommends: "CMS should develop policies for ensuring transparency when states (1) submit major changes to pending demonstration applications and (2) propose amendments to existing demonstrations. HHS concurred with these recommendations."
The text of the GAO report is available at https://www.gao.gov/products/GAO-19-315?utm_campaign=usgao_email&utm_content=daybook&utm_medium=email&utm_source=govdelivery
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