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CMS Skips Congressional Hearing Criticizing How Medicaid Demos Are Run

Author | Shield HealthCare
06/25/15  4:34 PM PST

The CMS needs to be more transparent in its evaluation and approval of Medicaid demonstrations, the Government Accountability Office said Wednesday. The GAO asked Congress to step in because billions are being overspent and it blames the CMS for lack of oversight it says endangers the Medicaid program. The CMS didn’t attend the hearing.

In fiscal 2011, Section 1115 demonstrations accounted for about one-fifth of Medicaid expenditures, rising to nearly one-third of total federal Medicaid expenditures in fiscal 2014, an estimated $89 billion in federal funds. The waivers allow states to experiment in their Medicaid programs to improve services to beneficiaries. Waivers must be budget-neutral, meaning the CMS is spending the same amount of money on a state that it would have spent without a waiver.

The GAO has issued multiple reports going back into the 1990s in which it noted that CMS’ process for approving state spending for demonstrations is opaque and doesn’t ensure that demonstrations will be budget-neutral.

The nonpartisan watchdog group says it found numerous cases in which states overspent by billions. For example, in 2013 and 2014, five demonstrations reviewed by the agency spent $33 billion more than what documentation would have supported.

“We’re concerned about the long-term stability of the Medicaid program,” Katherine Iritani, director of healthcare at the GAO said Wednesday in a hearing hosted by the House Energy and Commerce Committee’s Subcommittee on Health.

Despite the seriousness of the claims, the CMS declined to participate in the hearing, much to the frustration of lawmakers at the hearing.

“We gave the agency two weeks’ notice and offered two different potential hearing dates. Nevertheless, despite all the people that work at the CMS, the administration declined to make anyone available to testify,” said Rep. Joe Pitts (R-Pa.), chairman of the subcommittee.

Original article authored by Virgil Dickson of Modern Healthcare on June 24, 2015. Read the Full Article on Modern Healthcare.


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