GAO: Managed care growth putting Medicaid funds at risk

A lack of strategy has left Medicaid funds at risk, Dodaro says.
A lack of strategy has left Medicaid funds at risk, Dodaro says.

End-of-year comments from the comptroller general indicated ways the Medicaid and Medicare programs can continue to improve, including the Centers for Medicare & Medicaid Services increasing its oversight of Medicaid managed care program integrity. 

The growth of Medicaid managed care and increasing share of Medicaid expenditures, a lack of comprehensive program integrity strategy for the program “leaves a growing portion of Medicaid funds at risk,” according to December testimony from Gene L. Dodaro, comptroller general and head of the General Accountability Office, speaking to a Senate subcommittee. His testimony was on “Implementing GAO Recommendations Can Achieve Financial Benefits and Strengthen Government Performance.”

The Medicaid demonstration approval process continues to raise concern, as “demonstration waivers lack transparency and raises cost concerns,” his remarks state.

“We have a longstanding recommendation that HHS take certain steps to improve its budget neutrality process and policy so the basis for spending limits would be clear”; however, “HHS does not agree with our recommendation.”

The GAO recommended that CMS give audit support to states for Medicaid.

Since 1990, due to its size and vulnerability to improper payments, Medicare has been  designated by the GAO as a high-risk area. Medicaid received the same label in 2003.

The GAO also noted last year the need to reduce antipsychotic drug use in older adults. It made an average of 1,800 recommendations a year, with an average of about 80% implemented, between fiscal years 2010 and 2015.

The full testimony can be accessed at gao.gov/assets/680/674093.pdf.