Medicaid Managed Care: Rapid spending growth in state directed payments needs enhanced oversight and transparency : report to congressional addressees
- Collection:
- Health Policy and Services Research
- Alternate Title(s):
- Rapid spending growth in state directed payments needs enhanced oversight and transparency: report to congressional addressees
- Contributor(s):
- United States. Government Accountability Office, issuing body.
- Publication:
- Washington, DC : United States Government Accountability Office, December 2023
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Government Regulation Health Expenditures Managed Care Programs Medicaid State Health Plans United States Centers for Medicare & Medicaid Services (U.S.)
- Genre(s):
- Technical Report
- Abstract:
- Why GAO did this study. In 2022, spending for managed care represented more than half of the $800 billion spent on Medicaid. The percentage is expected to continue growing in the next decade. With few exceptions, states may not direct managed care plans’ payments to providers. However, CMS began allowing a new exception in 2017: state directed payments. Since then, states have made widespread use of directed payments; for example, to increase payments to safety net providers to ensure beneficiary access. Among other issues, this report describes estimated spending for, and state financing of, state directed payments, and examines CMS’s policies and procedures for approving these payments. GAO analyzed information on approved state directed payments in effect in 2022, and interviewed CMS and Medicaid officials from five states. These states were selected, in part, based on having a directed payment estimated at $1 billion or more in 2022. GAO assessed CMS’s policies and procedures against agency guidance and federal internal controls. What GAO recommends. GAO is making four recommendations to CMS, including to enhance the agency’s fiscal guardrails for approving state directed payments, review outcome information at renewal, and make publicly available additional approval documents. The Department of Health and Human Services agreed with two recommendations. It neither agreed nor disagreed with the other two recommendations, but noted CMS actions underway to address them.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (iii, 53 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918750688506676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918750688506676