Medicaid (31 - 40 of 363 items)
Medicaid: Information on Inmate Eligibility and Federal Costs for Allowable Services
GAO-14-752R: Published: Sep 5, 2014. Publicly Released: Oct 6, 2014.
In 2013, the Medicaid program financed health care services for more than 72 million individuals, and an additional 7 million beneficiaries are expected to enroll in 2014 as a result of states choosing to expand Medicaid eligibility as allowed under the Patient Protection and Affordable Care Act (PPACA). Most of these newly eligible individuals will be low-income adults, a population that may incl...
Disabled Dual-Eligible Beneficiaries: Integration of Medicare and Medicaid Benefits May Not Lead to Expected Medicare Savings
GAO-14-523: Published: Aug 29, 2014. Publicly Released: Sep 29, 2014.
Overall spending for high-expenditure disabled dual-eligible beneficiaries—those in the top 20 percent of spending in their respective states—was driven largely by Medicaid spending, and the service use and health status often differed widely between those with high Medicare expenditures and high Medicaid expenditures. For these beneficiaries, Medicaid expenditures accounted for nearly two-thi...
Medicaid Demonstrations: HHS's Approval Process for Arkansas's Medicaid Expansion Waiver Raises Cost Concerns
GAO-14-689R: Published: Aug 8, 2014. Publicly Released: Sep 8, 2014.
In approving Arkansas’s Medicaid Section 1115 demonstration, the Department of Health and Human Services (HHS) gave the state the authority to test whether providing premium assistance to purchase private coverage offered on the health insurance exchange will improve access to care for individuals newly eligible for Medicaid as a result of the Patient Protection and Affordable Care Act (PPACA).I...
Medicaid: Completed and Preliminary Work Indicate that Transparency around State Financing Methods and Payments to Providers Is Still Needed for Oversight
GAO-14-817T: Published: Jul 29, 2014. Publicly Released: Jul 29, 2014.
In its report being issued today (GAO-14-627), GAO found that states' reliance on funds from health care providers and local governments to finance Medicaid has increased in recent years, with implications for federal costs. In state fiscal year 2012, while most of the nonfederal share was from state general funds, states used funds from health care providers and local governments to finance 26 pe...
Medicaid: Financial Characteristics of Approved Applicants and Methods Used to Reduce Assets to Qualify for Nursing Home Coverage
GAO-14-473: Published: May 22, 2014. Publicly Released: Jun 23, 2014.
GAO's review of 294 approved Medicaid nursing home applications in three states showed that 41 percent of applicants had total resources—both countable and not countable as part of financial eligibility determination—of $2,500 or less and 14 percent had over $100,000 in total resources.Distribution of Approved Applicants in Selected Counties in Three States by Amount of Total Resources (n=294)...
Foster Children: Additional Federal Guidance Could Help States Better Plan for Oversight of Psychotropic Medications Administered by Managed-Care Organizations
GAO-14-362: Published: Apr 28, 2014. Publicly Released: May 22, 2014.
Two experts GAO contracted with reviewed foster and medical records for 24 cases in five selected states and found varying quality in the documentation supporting the use of psychotropic medications for children in foster care. Experts examined documentation related to several categories, such as (1) screening, assessment, and treatment planning; and (2) medication monitoring.Screening, Assessment...
Medicaid: Demographics and Service Usage of Certain High-Expenditure Beneficiaries
GAO-14-176: Published: Feb 19, 2014. Publicly Released: Feb 19, 2014.
In fiscal year 2009, states spent nearly a third (31.6 percent) of all Medicaid expenditures on the most expensive Medicaid-only beneficiaries, who were 4.3 percent of total Medicaid beneficiaries. States spent another third (33.1 percent) on all other Medicaid-only beneficiaries, who represented 81.2 percent of total Medicaid beneficiaries. Among dual eligible beneficiaries, a similar pattern exi...
Medicaid: Use of Claims Data for Analysis of Provider Payment Rates
GAO-14-56R: Published: Jan 6, 2014. Publicly Released: Jan 6, 2014.
Among the 9 states and 35 services examined, GAO found that all states varied Medicaid payments for at least some services. However, the states differed in the number of services for which they varied payments, in the factors that accounted for variation, and in the magnitude of the variation. Many of the states varied payment rates by at least one of the factors GAO was able to explore in detail:...
Children's Health Insurance: Information on Coverage of Services, Costs to Consumers, and Access to Care in CHIP and Other Sources of Insurance
GAO-14-40: Published: Nov 21, 2013. Publicly Released: Dec 20, 2013.
In five selected states, GAO determined that the separate State Children's Health Insurance Program (CHIP) plans were generally comparable to the benchmark plans selected by states in 2012 as models for the benefits that will be offered through qualified health plans (QHP) in 2014. The plans were comparable in the services they covered and the services on which they imposed limits, although there...
Medicare Program Integrity: Contractors Reported Generating Savings, but CMS Could Improve Its Oversight
GAO-14-111: Published: Oct 25, 2013. Publicly Released: Nov 25, 2013.
The Centers for Medicare and Medicaid Services (CMS) paid its Zone Program Integrity Contractors (ZPIC) about $108 million in 2012. ZPICs reported spending most of this funding on fraud case development, primarily for investigative staff, who in 2012 reported conducting about 3,600 beneficiary interviews, almost 780 onsite inspections, and reviews of more than 200,000 Medicare claims.ZPICs reporte...