GAO: States' evaluations of Medicaid demonstrations have 'significant limitations'

States' evaluations of Medicaid demonstrations often included gaps in information necessary to fully determine efficiency and effectiveness, according to a new report from the U.S. Government Accountability Office.

HHS may approve demonstrations, per Section 1115 of the Social Security Act, to allow states to test approaches to their Medicaid programs. The purpose of these demonstrations is to study and evaluate state-specific initiatives to determine ways of better serving Medicaid beneficiaries.

But the GAO said it found states and the federal government cannot conclusively say whether these demonstrations save money or improve care because of lack of complete and timely evaluation information.

The agency examined evaluations from eight states with high demonstration spending as well as ongoing federal evaluations and interviews with state and federal Medicaid officials.

According to the GAO, states' evaluations of Medicaid demonstrations often had "significant limitations" such as missing evaluation results information. For instance, the agency said Arizona's demonstration, which involved a managed care model to deliver long-term services and support, did not have information on crucial measures that would help determine whether the demonstration improved access and quality of care.

Officials partially attributed the significant limitations to the fact CMS required final evaluations after the demonstrations expired instead of when each three- to five-year demonstration cycle ended. The GAO notes CMS said late last year said it plans to require reports when the demonstration cycles end, but written procedures for implementing those rules have not been created. The GAO said criteria also has not been created regarding when CMS would allow limited evaluations from states for particular initiatives, as planned.

In addition to states, the GAO also found limitations in evaluations from the federal government. The agency said this was because of data challenges, such as delays obtaining state data.

Ultimately, the GAO recommended CMS "establish written procedures for requiring final evaluation reports at the end of each demonstration cycle, issue criteria for when it will allow limited evaluations of demonstrations, and establish a policy for publicly releasing findings from federal evaluations of demonstrations." The agency said HHS agreed with its recommendations.


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