The U.S. Governmental Accountability Office (GAO) has issued a new report to Congress identifying key issues facing the Medicaid program and urging greater federal oversight. The report comes at a time of significant transformation for the Medicaid program, which is currently celebrating its 50th year. Following its historic expansion as a result of the Affordable Care Act to provide health care coverage to approximately 70 million individuals nationwide, multiple bills are pending in Congress that would affect the scope of Medicaid program benefits and coverage, including legislation that would modify coverage of behavioral health services or increase payments for primary care services. In addition, the Centers for Medicare and Medicaid Services (CMS) currently is reviewing stakeholder comments on its proposed, comprehensive revisions to the federal Medicaid managed care regulations.
The GAO designated Medicaid as a “high risk” program, based on the size and diversity of the program and its concerns about gaps in federal oversight. The GAO report concludes that Medicaid’s “ongoing transformation,” including increases in enrollment and spending and the introduction of telemedicine and other new technology and services, highlights the need for increased federal oversight. The report summarizes key issues and challenges for the program identified by the GAO over the past ten years, which the GAO believes should continue to warrant attention.
In general, most Medicaid enrollees report having access to care that is comparable to that of individuals with private insurance. However, the GAO raises concerns that certain populations, such as Medicaid enrollees with more significant health needs, are more likely to experience difficulty obtaining specialty care, including mental health, dental care, obstetrical/gynecological, pediatric, and surgical specialty services. In addition, Medicaid beneficiaries are more likely to have chronic health conditions such as obesity and diabetes that can be treated through preventive services. The GAO reports that Medicaid coverage of preventive services varies greatly among the states. To assist with federal oversight, the GAO recommends better data reporting by states, particularly in the context of managed care, to allow CMS to assess Medicaid enrollees’ access to care and identify areas for improvement.
The GAO raised several concerns related to transparency and federal oversight of the Medicaid program, and recommended more robust data collection efforts, including the following:
The GAO believes that the size and diversity of the Medicaid program make it particularly vulnerable to improper payments, and that more coordinated and cost-effective program integrity efforts are needed. Specific recommendations highlighted by the report include:
The GAO also reiterated earlier recommendations for improving the federal-state partnership by revising the federal funding formula to be more responsive to states’ needs.