Not Surprisingly, Higher Medicaid Rates Improve Access

Higher Medicaid payments for substance abuse disorder treatment lead to better access to such treatment, a new report by the U.S. Government Accountability Office has concluded.

According to the study, which focused on six states,

State officials and SUD [substance abuse disorders] providers in the selected states with larger rate changes reported greater effects on SUD service availability compared to those in states with smaller changes. For example, state officials said that larger rate increases helped increase the number of SUD providers participating in Medicaid, but did not generally note SUD service availability effects for smaller rate increases.  Providers in selected states identified certain factors, such as Medicaid program requirements, that could affect how much the availability of SUD services increased or decreased following rate changes.

The communities served by private safety-net hospitals often have larger numbers of residents with substance abuse disorders than most communities, making this a major challenge for such hospitals.

Learn more about how Medicaid rates affect access to substance abuse disorder services in the new GAO report Medicaid:  States’ Changes to Payment Rates for Substance Use Disorder Services.


Medicaid Waiver Process Often Lacks Transparency, GAO Finds

States’ applications for federal Medicaid waivers often lack transparency, according to a new report by the U.S. Government Accountability Office.

According to the GAO, the chief problem with the transparency of state applications for Medicaid waivers arises when states either seek to amend waivers they have already obtained or amend waiver applications currently under review by the Centers for Medicare & Medicaid Services.  Too often, the GAO found, states neither subject such amendments to public review and comment nor adequately explain to stakeholders the implications of the amendments they are proposing.

To address this problem, the GAO recommends that CMS address these shortcomings.  CMS agrees with these recommendations.

States often use section 1115 Medicaid waivers to seek exemptions from selected aspects of federal Medicaid law so they can employ new approaches to the delivery of Medicaid services and to payment for those services. Because they serve so many more Medicaid patients than most hospitals, private safety-net hospitals have a much greater stake in changes in state Medicaid programs than other hospitals.

Learn more about why the GAO undertook this analysis and what it found in its report Medicaid Demonstrations:  Approvals of Major Changes Need Increased Transparency.

Behavioral Health Services in Medicaid Expansion States

The U.S. Government Accountability Office has performed a limited study of the utilization of Medicaid behavioral health services in Medicaid expansion states.

The study, based on data from New York, Washington, Iowa, and West Virginia, found that the two most heavily utilized behavioral health services were diagnostic and psychotherapy services and that more than two-thirds of behavioral health patients were prescribed anti-depressants.  More people sought help for mental health challenges that for substance abuse problems.

Medicaid officials in the selected states concluded that enrollment in Medicaid enhanced access to behavioral health care.

Learn more about the study’s findings in the GAO report Medicaid Expansion:  Behavioral Health Treatment Use in Selected States in 2014, which can be found here.

HHS Needs to Do More on Physician Training

The federal government needs to do more to ensure an adequate supply of primary care physicians and their deployment in non-urban areas outside of the northeastern U.S.

Or so concludes a new study performed by the U.S. Governor Accountability Office.

According to the GAO report, efforts by the U.S. Department of Health and Human Services have resulted in progress toward meeting both of these goals – but not enough progress.  With the federal government spending $15 billion on graduate medical education, GAO believes, HHS can and should do more to ensure an adequate supply of primary care physicians throughout the country and not just in urban areas.

Many private safety-net hospitals are teaching hospitals.

Learn more about what the GAO found and what it recommended in its new report Physician Workforce: Locations and Types of Graduate Training Were Largely Unchanged, and Federal Efforts May Not Be Sufficient to Meet Needs, which can be found here.

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.

gaoIn 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.


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.

gaoIn 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.

GAO Calls for Look at Medicare Outpatient Payments

Citing the growing consolidation of hospitals and physician practices and the higher rates Medicare pays for care delivered in hospital outpatient departments, the U.S. Government Accountability Office (GAO) has recommended that Congress

…consider directing the Secretary of the Department of Health and Human Services to equalize payment rates between settings for E/M [evaluation and management] office visits…

gaoThe recommendation comes after a GAO study that documented the increase in “vertical consolidation” between hospitals and physician practices in recent years and the increased costs for outpatient services this leads to for the Medicare program. The GAO report notes that “Such excess payments are inconsistent with Medicare’s role as an efficient purchaser of health care services.” It also notes that Medicare lacks the statutory authority to make such changes on its own.

For a closer look at this issue and why it is commanding the attention of the GAO and others, go here to see the GAO report Increasing Hospital-Physician Consolidation Highlights Need for Payment Reform.

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 gao(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.

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.

GAO Looks at Behavioral Health Options

gaoAccess 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 the nation’s private 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.

GAO Identifies Medicaid Challenges

As Medicaid marks its 50th anniversary, the U.S. Government Accountability Office (GAO) testified recently before the House Energy and Commerce Committee’s Health Subcommittee on the major challenges facing the program.

GAO’s testimony focused on four major issues:

  • gaoaccess to care
  • transparency and oversight
  • program integrity
  • federal financing

The GAO concluded that it

…considers Medicaid a high-risk program due to its size, growth, diversity, and gaps in oversight…

See GAO’s complete testimony here.