State Medicaid Programs Lack Oversight

The New York Times gives an example why block-granting programs to states is usually not a good idea.For the GAO report see Long-Term Care: Federal Oversight of Growing Medicaid Home and Community-Based Waivers Should Be Strengthened. GAO-03-576, June 20, or just the Highlights. Report Criticizes Federal Oversight of State MedicaidThe Bush administration has allowed states to make vast changes in Medicaid but has not held them accountable for the quality of care they provide to poor elderly and disabled people, Congressional investigators said today.The administration often boasts that it has approved record numbers of Medicaid waivers, which exempt states from some federal regulations and give them broad discretion to decide who gets what services. But the investigators, from the General Accounting Office, said the secretary of health and human services, Tommy G. Thompson, had "not fully complied with the statutory and regulatory requirements" to monitor the quality of care under such waivers.The accounting office examined 15 of the largest waivers, covering services to 266,700 elderly people in 15 states and found problems with the quality of care in 11 of the programs. In many cases, Medicaid beneficiaries simply did not receive the services they were supposed to receive.The Medicaid beneficiaries were all eligible for nursing-home care but chose to stay in the community with friends and relatives. Rather than pay the high cost of institutional care, the states promised to provide a wide range of social and medical services known as home and community-based care.The General Accounting Office said, however, that the states often failed to provide those services and that the federal Department of Health and Human Services took no action to protect patients.
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