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This story was initially revealed by Actual Clear Wire
by Adam Andrzejewski
actual clear wire
Prime Line: State governments spent $38.5 billion to extend Medicaid funds in 2022, however there may be little oversight over how the cash is getting used, the U.S. Authorities Accountability Workplace stories.
Vital information: Sometimes, state governments ship cash to Medicaid Managed Care, which makes funds to well being care facilities on behalf of sufferers as wanted.
However since 2017, states have been allowed to ship further cash on to clinics in an effort to enhance well being care high quality. This observe was initially meant for use sparingly, however it’s turning into extra frequent.
State governments will spend greater than $38.5 billion in 2022 on these “directed funds,” that are managed by the Facilities for Medicare and Medicaid Providers.
However in accordance with GAO, there are “weaknesses” in “CMS processes for approving such funds.”
The report stated CMS has “weak fiscal guardrails,” which means states usually don't observe whether or not a well being care supplier is utilizing its funds successfully earlier than sending more cash. .
GAO evaluated 5 states and located that none of them have been “constantly” evaluating whether or not the extra billions of {dollars} spent on Medicaid have been truly having an impression on affected person outcomes. In Texas, some hospitals acquired greater than double the usual quantity, with no oversight.
The explanations for this drawback have been diversified. Some states had defective knowledge software program; Some individuals have been merely “not implementing finest practices.”
CMS has not set any specific limits on the sum of money any well being care supplier can obtain.
background: Eighteen states spent greater than $500 million on directed funds in 2022, with California and Texas every giving practically $7 billion.
Many of the cash got here from taxes on non-public well being care suppliers, whereas some got here from the state common fund and different sources.
America will spend a complete of $804 billion on Medicaid in 2022.
Abstract: States are gaining extra affect yearly over how Medicaid funds are distributed, but they don’t have satisfactory techniques in place to forestall probably wasteful spending.
#WasteOfTheDay is delivered to you by the forensic auditors at OpenTheBooks.com
This text was initially revealed by RealClearInvestigations and made accessible through RealClearWire.