WASHINGTON – The government should do a better job of providing oversight of state Medicaid finances, according to a March report issued by the General Accountability Office.
The 54-page report, written for the Senate Finance Committee, said the Centers for Medicare & Medicaid Services should be more transparent and consistent in its dealings. CMS is responsible for the oversight of Medicaid spending for some 60 million low-income recipients; that spending totaled $317 billion in fiscal year 2005, which ended Sept. 30, 2005.
The GAO report looked at a 2003 CMS initiative to put a stop to “inappropriate financing arrangements” used in the past by some states to collect federal Medicaid funding.
“CMS has not implemented its initiative transparently, contributing to concerns about the consistency of its reviews of state financing arrangements,” said Kathryn Allen, director of health care at the GAO.
After examining CMS documents and interviewing CMS and state officials, GAO recommended that CMS issue guidance to clarify allowable financing arrangements and explain its determinations in writing to states and interested parties, Allen said.
CMS Acting Administrator Leslie Norwalk disagreed with the findings. “GAO does not offer any recommendations that suggest that we could have achieved more positive results than we have,” she said in a response to Allen. “We are concerned that the report appears to place greater emphasis on transparency and process, rather than on outcome.”
Norwalk questioned the need for more transparency. States want to keep their financial methodologies private from the public eye, and recent discussions between states and the federal government have become “extremely delicate,” she said. Greater public scrutiny would have made interactions between CMS and states even more difficult, she contended.