CMS report doesn't please critics of Medicaid waiver process

October 18, 2015

A report to Congress on the transparency of Medicaid demonstration waivers is doing little to quell concerns that CMS needs to beef up its oversight of the policy experiments. The document is largely a recap of guidance the CMS issued over the last decade related to Medicaid waivers. Experts say it fails to explain how the federal government decides whether to approve or reject a state's application. The oversight of Medicaid's 1115 waivers was the topic of two hearings this past summer and multiple GAO reports. As of Sept. 2015, there were 55 approved Section 1115 demonstration projects in operation in 38 states. They accounted for nearly one-third of all Medicaid expenditures in fiscal 2014, about $89 billion, up from one-fifth in fiscal 2011. The GAO, in reports dating into the 1990s, criticized CMS process for approving state spending for demonstrations as opaque. The CMS also has failed to ensure the experiments don't add to Medicaid spending, according to the GAO. Experts also questioned why the report to Congress indicates CMS notified state Medicaid directors in an April 2012 letter that they must subject amendments to a demonstration waiver to the same public comment process as the initial application. The actual letter describes the comment period as optional.
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