State Medicaid Systems Need Improvement – GAO


A new report out from the GAO suggests that state IT systems may not be up to snuff when it comes to judging Medicaid eligibility. The March 2 report says that even while some states have recently updated Medicaid Management Information Systems (MIMS), there is no requirement for state officials to track the effectiveness of those systems. As such, it is unclear whether updates were actually useful in achieving desired outcomes. This situation is likely to remain this way if a new GAO report released yesterday is any indication. In that report, the GAO says government responds to approximately 30% of its improvement suggestions.

According to the report, states have implemented a wide variety of IT systems to manage Medicaid services, and apart from basic compliance with CMS mandates, there is no overarching standard for these systems or a metric to quantify effectiveness. The bulk of these systems have also been put in place using funding from CMS.

In a letter to Senator Carper included in the GAO report, authors note that Medicaid systems are particularly vulnerable to waste, fraud, and abuse and without proper tracking the problem is only expected to grow. Senator Carper requested the examination in his role as ranking member on the Committee for Homeland Security and Government Affairs. The GAO examined 9 states and the US Virgin Islands for the report, which was meant to be a representative sample of systems throughout the US.

Three of the states examined by the GAO as part of this report were still implementing systems put in place over 20 years ago that do not reflect the new realities of Medicaid management and eligibility.

Seven states included in the report had implemented additional systems to update procedures but only three states measured outcomes at all.

CMS has concurred with the GAO that more needs to be done to measure the outcomes of these systems and to justify the funding for upgrades, however no specific guidance has been proposed.

In another report released yesterday by the GAO, 440 actions across 180 areas of government have been recommended by the accountability office which would stave off waste, fraud and abuse. However, as of the end of last year only 30% of the recommendations had been addressed. The GAO predicts that approximately $80 billion in savings could be realized by responding to times included in the reports.