GAO Archives - Safety-Net Association of Pennsylvania

GAO Looks at Supplemental Medicaid Payments

Following up its own 2012 report that identified more than 500 hospitals receiving supplemental Medicaid payments that resulted in Medicaid payment surpluses, the U.S. Government Accountability Office has taken a broader look at supplemental payments state Medicaid programs make to hospitals and how those payments are used.
In a limited study of hospitals in four states, GAO found that some hospitals used supplemental payments for purposes other than serving Medicaid patients and the uninsured – purposes such as ordinary operations, capital purchases, a poison control center, even a helicopter. GAO also found that hospitals were more likely to receive such payments if local funding was used to draw down federal Medicaid matching funds. In some places, hospitals with local governments willing to finance the payments were more likely to receive them than hospitals located in places without such local support.
The GAO recommended that the Centers for Medicare & Medicaid Services take stronger steps to ensure that supplemental Medicaid payments are linked to the provision of Medicaid services and that CMS not permit states to make those payments contingent on local financing.
Learn more about why the GAO looked at supplemental Medicaid payments, what it learned, and what it recommended in the report Federal Guidance Needed to Address Concerns About Distribution of Supplemental Payments.

PA Safety Net Admin2016-03-09T06:00:15+00:00March 9th, 2016|Uncategorized|Comments Off

GAO Suggests Changes in Federal Medicaid Funding Formula

The U.S. Government Accountability Office has recommended changes in how the federal government matches state Medicaid funding for its share of overall Medicaid spending.
In testimony submitted to the House Energy and Commerce Committee’s Health Subcommittee, GAO reminded Congress that in the past

…GAO has examined multiple concerns regarding how the FMAP [federal medical assistance formula] allocates funds among states, including during times of economic downturn, and has suggested improvements.

In particular, the GAO is concerned about how the FMAP formula’s use of per capita income in targeting federal Medicaid matching funds may not accurate reflect economic conditions at the state level, especially during economic downturns, and fail to respond to states’ individual needs during those downturns.
In response to these concerns, the GAO suggested

…that Congress could consider an FMAP formula that targets variable state Medicaid needs and provides automatic, timely, and temporary assistance in response to national economic downturns.

For a closer look at what the GAO investigated, what it concluded, and what it recommended to Congress, go here to see the GAO report Medicaid: Changes to Funding Formula Could Improve Allocation of Funds to States.

PA Safety Net Admin2016-02-18T06:00:32+00:00February 18th, 2016|Uncategorized|Comments Off

GAO: More Information Needed About Supplemental Medicaid Payments

More data is needed about the supplemental Medicaid payments states make to hospitals and how those payments are financed, according to a new report from the U.S. Government Accountability Office (GAO).
According to the GAO, states are increasingly funding non-disproportionate share (Medicaid DSH) supplemental Medicaid payments to hospitals with funds from local governments and providers that are then matched by the federal government. In some states those supplemental payments, with the help of federal Medicaid matching funds, result in hospitals receiving reimbursement from Medicaid that exceeds the cost of the care they provide to their Medicaid patients.
Pennsylvania’s safety-net hospitals receive a number of such supplemental Medicaid payments.
In response to this concern, the GAO has urged the Centers for Medicare & Medicaid Services (CMS) to collect more and better data about how states finance their Medicaid programs and to do more to ensure that accuracy of that data. For its part, CMS maintains that its current efforts are adequate.
Learn more about this issue from the GAO report Improving Transparency and Accountability of Supplemental Payments and State Financing Methods, which can be found here.

PA Safety Net Admin2015-11-13T06:00:33+00:00November 13th, 2015|Medicaid supplemental payments, Pennsylvania safety-net hospitals|Comments Off

GAO Looks at Behavioral Health Options

Access to behavioral health services can be a challenge for low-income adults, so the U.S. Government Accountability Office (GAO) recently looked into those challenges.
In a new report, the GAO examined how many low-income adults have behavioral health problems, where they can go to receive the care they need – including whether there are differences in those options depending on whether the state in which the reside has expanded its Medicaid program – how Medicaid expansion states are providing coverage for behavioral health for newly eligible beneficiaries, and how obtaining Medicaid coverage affects the ability of such individuals to get the care they seek.
Access to behavioral health care can be an especially major challenge in the low-income communities typically served by Pennsylvania’s safety-net hospitals.
Read about the GAO’s findings in the report Options for Low-Income Adults to Receive Treatment in Selected States, which you can find here.

PA Safety Net Admin2015-07-24T06:00:04+00:00July 24th, 2015|Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

5% of Medicaid Recipients Account for 50% of Costs

Just five percent of all Medicaid recipients are responsible for nearly half of the program’s expenditures.
Or so says a new report by the U.S. Government Accountability Office (GAO).
Conversely, the 50 percent of Medicaid’s least costly recipients account for only eight percent of the program’s costs.
Disabled Medicaid recipients, while fewer than 10 percent of the overall total, represent nearly two-thirds of the highest-cost group.
These figures reflect spending from 2009 through 2011.
The greatest Medicaid expenditures were invested in seven types of care: for patients with asthma, diabetes, HIV/AIDS, mental health conditions, substance abuse, and delivery or childbirth along with those residing in long-term-care facilities.
To learn more about the GAO’s findings, see a summary of the report Medicaid: A Small Share of Enrollees Consistently Accounted for a Large Share of Expenditures and find a link to the complete report here on the GAO web site.

PA Safety Net Admin2015-05-14T06:00:46+00:00May 14th, 2015|Uncategorized|Comments Off

GAO Questions Cost of Private Market Medicaid Expansion

Permitting states to use Medicaid money to enable newly eligible Medicaid recipients to purchase health insurance on the private market may cost more than expansion of traditional state Medicaid programs.
Or so says the U.S. Government Accountability Office (GAO).
Writing in response to a request from the chairman of the House Energy and Commerce Committee and the ranking minority member of the Senate Finance Committee to look at the approved federal waiver that will permit Arkansas to expand its Medicaid program through the purchase of private insurance for newly eligible recipients, the GAO concluded that the federal government may spend $778 million more over three years on such an approach than it would have spent if the state had expanded its traditional Medicaid program.
The GAO said that the U.S. Department of Health and Human Services (HHS) did not perform a budget-neutrality calculation, which would have revealed the increased cost, instead accepting the state’s alternative methodology for determining cost-effectiveness.
Arkansas officials rejected the GAO’s conclusions, asserting that newly eligible Medicaid recipients would have been unable to find providers willing to serve them under a traditional Medicaid expansion.
GAO concluded that CMS may be approving waivers that are not budget-neutral. CMS disagreed with this conclusion.
The GAO letter, written before HHS granted Pennsylvania its Medicaid waiver, specifically mentions Pennsylvania as another state seeking to expand its Medicaid program through the purchase of private insurance for newly eligible Medicaid recipients.
Learn more about the GAO analysis, why it was undertaken, and what it found by reading the GAO letter to the two members of Congress who requested the analysis.

PA Safety Net Admin2014-09-16T06:00:21+00:00September 16th, 2014|Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy|Comments Off

GAO Questions State Medicaid Financing

States are now financing more than a quarter of their share of Medicaid expenditures with money from sources other than state general funds, according to a new study by the Government Accountability Office (GAO).
According to the GAO, 26 percent of state share of Medicaid funding comes from taxes on health care providers, transfers from local governments and local government providers, and other sources. Such funding, the GAO noted, shifts additional Medicaid costs to the federal government.
Pennsylvania uses such funding mechanisms, including its gross receipts tax on Medicaid managed care organizations and state-wide and Philadelphia hospital assessments.
Exacerbating this problem, the GAO reports, is that the Centers for Medicare & Medicaid Services (CMS), which oversees Medicaid, does not assure that it receives complete and accurate data on funding sources from the states, leaving CMS without a complete understanding of how states are financing their Medicaid expenditures. In the report, the GAO recommends a stronger CMS effort to gather such data – a recommendation that CMS did not accept.
Learn more about the GAO study “States Increased Reliance on Funds From Health Care Providers and Local Governments Warrants Improved CMS Data Collection” by finding the complete report and a summary here, on the GAO web site.

PA Safety Net Admin2014-07-31T06:00:42+00:00July 31st, 2014|Pennsylvania Medicaid policy|Comments Off

GAO Finds Problems With Medicaid DSH Payments

The U.S. Government Accountability Office (GAO) is now reviewing audits of states’ Medicaid disproportionate share payments (Medicaid DSH) to hospitals and is raising questions about states’ compliance with federal requirements for those payments.
Based on its analysis of state Medicaid DSH audits, GAO found that states are making Medicaid DSH payments to hospitals that exceed those hospitals’ uncompensated care costs and are inaccurately calculating those hospital uncompensated care costs. The GAO also found that states are not always targeting their Medicaid DSH payments to the hospitals that provide the most uncompensated care.
States are required to submit audits and data as a condition of receiving Medicaid DSH funds from the federal government. Currently, the Centers for Medicare & Medicaid Services (CMS) is not acting on the information it receives but will begin doing so after a transition period that ends when 2014 audits are completed. In anticipation of that time, GAO is reviewing the information CMS receives for state compliance with six federal standards for Medicaid DSH payments.
This data also may eventually be used to help implement the Medicaid DSH payment reduction mandated under the Affordable Care Act.
According to the report, Pennsylvania did not provide some of the required data, so in several instances in which the document provides specific information about individual state performance, it has nothing about Pennsylvania. It does note, however, that in FY 2007, six hospitals in the state received Medicaid payments greater than their Medicaid costs.
Because Pennsylvania’s safety-net hospitals care for so many uninsured and low-income patients and receive higher Medicaid DSH payments than other hospitals, they are far more dependent on these payments than other hospitals and will need to watch this situation closely in the future.
Learn more about GAO’s examination of Medicaid DSH payments – why it is undertaking this review, what it found, and how its findings may be used in the future – in the report More Transparency of and Accountability for Supplemental Payments are Needed, which can be found here , on GAO’s web site.

PA Safety Net Admin2012-12-28T06:00:33+00:00December 28th, 2012|Health care reform, Medicaid supplemental payments, Pennsylvania Medicaid policy|Comments Off

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