To celebrate Medicaid's 50th birthday, the Government Accountability Office is taking a look at all the ways it has told the CMS to improve the program, but the agency has yet to act on.
In a 90-plus page report released Thursday, the watchdog agency took a walk down memory lane, reviewing reports on Medicaid dating to January 2005.
In all, the GAO has made more than 80 recommendations regarding Medicaid, some of which the CMS has implemented. But there are numerous suggestions that have fallen on deaf ears, and, the GAO says, if only they were implemented, program integrity and oversight could be improved.
The GAO has for some time wanted the CMS to get to the bottom of how states finance their share of Medicaid. Additional data is needed to ensure that states comply with federal requirements regarding how much local governments may contribute to the non-federal share.
"Given states' increased reliance on non-state sources to fund the non-federal share of Medicaid, which can result in costs shifting to the federal government, we continue to believe that data are needed to improve transparency and oversight, such as to understand how increased federal costs may affect beneficiaries and the providers who serve them," according to the report.
Another common theme that's potentially resulting in billions of unnecessary federal spending is the need to improve oversight on Medicaid demonstration waivers. The agency needs to do more to ensure that they don't significantly increase federal spending for Medicaid, and that the experiments actually further Medicaid objectives.
The CMS attempted to bring a bit more transparency and expediency to its waiver process this week by announcing a streamlined process for renewing waivers that have long been in place.
However, the gesture seems to be more about addressing state concerns versus those of the GAO's, said Katherine Iritani, director of healthcare at the oversight agency.
The GAO says the CMS should move as quickly as it can to address these and other recommendations not acted on, especially as millions join Medicaid under expansion outlined in the Affordable Care Act.
The CMS can look forward to even more recommendations from GAO, as it has multiple ongoing studies related to the program, it says.