The CMS is doing a poor job in ensuring the public knows about major changes to Medicaid, including the installation of work requirements, a federal watchdog said Friday.
The Government Accountability Office's report found that the CMS has limited transparency for amendments to existing Section 1115 waivers. That has allowed some states to score approval for their work requirements while skirting some rules, such as projecting how the changes will impact Medicaid enrollment.
The government watchdog noted that two of the four states it studied did not seek public comment on changes that could significantly impact Medicaid beneficiaries.
The transparency requirements for an amendment are more relaxed than a new waiver application, the GAO said. Arkansas and New Hampshire both added work requirements to their Medicaid programs through amendments to their existing Section 1115 waivers.
Currently, new waivers or extension requests must include whether the state thinks that enrollment will decrease and any spending changes. While amendments must address the impact on beneficiaries and explain the changes, there are fewer requirements for what information must be disseminated to the public.
The GAO also found that the CMS had inconsistent transparency requirements for amendments.
For example, the CMS determined Massachusetts' amendment to waive non-emergency medical transportation was incomplete because the application didn't include a revised design plan. However, the CMS approved Arkansas' work requirement amendment even though it did not include a revised design plan.
The GAO recommended that the CMS develop standard transparency requirements for new waivers, extension requests and significant Section 1115 amendments.
In a response, HHS said it has already implemented policies to improve transparency. GAO said those changes "do not apply to amendments."
The CMS also lacks policies for ensuring that major changes to a pending application are transparent.
The report comes as the Trump administration is appealing a federal judge's decision to strike down Medicaid work requirement programs in Kentucky and Arkansas.
Seven other states have received CMS approval for work requirements. Those states are Arizona, Indiana, Michigan, New Hampshire, Ohio, Utah and Wisconsin. Another six states—Alabama, Mississippi, Oklahoma, South Dakota, Tennessee and Virginia—have applications pending federal approval.