GAO Sees Transparency Trouble with HHS and Medicaid Programs

The Government Accountability Office released a report today which says the Department of Health and Human Services lacks transparency in how it makes approval decisions about billions of dollars in experimental projects in the Medicaid program.

At issue are “1115 waivers” that the federal government grants to allow states to run test programs that would not otherwise be allowed under Medicaid. For example, states could alter the eligibility or benefits under Medicaid, the government health insurance program for the poor. HHS has not issued specific criteria for making these determinations and findings show that HHS’s decision-making on whether to approve these waivers is not always clear.

The waivers apply to about $150 billion in spending, or about one-third of Medicaid dollars.

The report cites the issue as one of lack of transparency.Without clear criteria for assessing how proposed expenditure authorities states are seeking will promote Medicaid objectives, and without clear documentation of the application of those criteria, the bases for HHS’s decisions involving tens of billions of Medicaid dollars are not transparent to Congress, states, or the public.

HHS largely agreed, in the response section of the report, that it needs to clarify the process. It said it will more clearly articulate how section 1115 authority is being used to assist states in addressing evolving trends or needs in their Medicaid programs.

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