On February 6, 2017, the U.S. Government Accountability Office (GAO) issued a report on the Medicaid program entitled, “Program Oversight Hampered by Data Challenges, Underscoring the Need for Continued Improvement.” Six members of the U.S. Senate and the House of Representatives asked GAO to examine Medicaid data challenges based on estimates that there were about $36.3 billion in improper Medicaid payments in Federal fiscal year 2016.
The GAO report describes on-going efforts by the Centers for Medicare and Medicaid Services (CMS) and state Medicaid agencies to manage the transition from long-standing CMS reporting systems to more advanced systems such as the Transformed Medicaid Statistical Information System (T-MSIS). By October 2016, 18 states could submit T-MSIS data to CMS while about 30 states were working on replacing legacy Medicaid information technology in order to meet T-MSIS and other CMS IT requirements. The GAO report also reviews challenges in areas such as obtaining accurate and timely Medicaid managed care encounter data, another vital issue as about 75 percent of Medicaid recipients are now enrolled in various forms of managed care.
A copy the GAO report, including GAO’s letter to Congress and HHS/CMS comments on GAO’s findings, is available here.