Verma Unveils State Medicaid Scorecard But Refuses To Judge Efforts


By Phil Galewitz

The Trump administration Monday released a Medicaid “scorecard” intended to show how the nation’s largest health program is performing. But the nation’s top Medicaid official didn’t want to draw any conclusions.

“This is about bringing a level of transparency and accountability to the Medicaid program that we have never had before,” said Seema Verma, administrator of the Centers for Medicare & Medicaid Services.

Yet in a meeting with reporters, Verma refused to discuss the findings in any detail or comment on any individual states that performed poorly or exceptionally.

“I will let you look at the data and make your own conclusions,” she told journalists a few minutes before the report was posted online.

When reporters pressed Verma to comment on the document, she refused to give an assessment of the Medicaid program, the federal-state health program for low-income residents. She has run Medicaid for the past 15 months.

“The idea here is to give you a sense of where states are on different areas,” she said. “The idea is to be used for best practices,” and it’s “an opportunity for us to identify” and have discussions with states that aren’t performing well.

Medicaid covers about 75 million people, about half of them children.

The report looked at how well states provide a wide variety of health services to children and adults. It also reviewed how quickly the federal government was approving state waiver requests to change their programs.

But not all states provided data for each service because sharing information was voluntary.

For example, half the states did not show how well they control Medicaid enrollees’ blood pressure.

The National Association of Medicaid Directors panned the scorecard. It acknowledged the need for a system to measure performance but said its members have concerns about its accuracy and usefulness.

“There are significant methodological issues with the underlying data, including completeness, timeliness, and quality,” the association said in a statement. It noted that most of the data comes from 2015.

As expected, the data showed great variation in how states provide care, including immunizing teenagers or getting dental care to children. A big reason is that state Medicaid benefits and payments to doctors vary dramatically, the Medicaid directors said, so that “it will not be possible to make apples-to-apples comparisons between states.”

In her first public speech, Verma promised last November to release a Medicaid scorecard. She said states won’t immediately face any consequences for poor performance — but that could change.

“The data … begins to offer taxpayers insights into how their dollars are being spent and the impact those dollars have on health outcomes,” Verma said Monday.

Sara Rosenbaum, a professor of health law and policy at George Washington University in Washington, D.C., who previously led a congressional advisory board on Medicaid, suggested that the information is still too incomplete to be of great value.

“It is amazing to me that in 2018 this is all we have when trying to understand how the nation’s largest insurer performs for its poorest and most vulnerable residents,” she said.

This story was provided by Kaiser Health New. KHN’s coverage of children’s health care issues is supported in part by the Heising-Simons Foundation.