A recent report by the Government Accountability Office (GAO) claims state and federal agencies tasked with evaluating experimental programs from the Centers for Medicare and Medicaid Studies (CMS) fail to properly evaluate the initiatives. According to the report, some states can take years to finish evaluations and complete reports on programs implemented to help save taxpayers money and improve patient care.
Furthermore, when reports do become available CMS often fails to give the public access in order for ordinary people to see for themselves what works and what does not for the working poor of America. While many experts studying the issue found the shortcomings to be troubling, many were not surprised at the way states and federal agencies go about evaluating what incremental changes to CMS programs could be worthwhile.
Some states do not even finish their evaluations and complete reports until after the federal government approves the experiments for a second time. Such moves often leave observers scratching their heads as to how states can continue to receive funding for experiments on CMS programs without even taking into account whether they have a positive impact on the health and wellness of state residents or the programs fiscal soundness.
The CMS experiments in questions are often referred to as “demonstration projects” or “1115 demonstration waivers,” terms that are derived from the portions of federal law that allow the programs to take place. Under the provisions, federal agencies can allow states to test new approaches to providing coverage and are used to extend Medicaid to people or services not generally covered or to change payment systems to improve care.
These Medicaid demonstration programs can run for a decade or more and have been used by states like Indiana, Iowa, Arkansas and New Hampshire which expanded Medicaid eligibility under the Affordable Care Act (ACA). Almost 75 percent of states utilize Medicaid demonstration projects and about one-third of the federal government’s Medicaid spending goes towards these types of programs which can include testing providing services through private managed-care firms and requiring enrollees to pay monthly premiums.
Some states like Arizona, Kansas, Maryland, Massachusetts, and California spend over half of their Medicaid funding on demonstration programs. While some states use demonstration programs to help expand Medicaid to insure more state residents, others like Indiana and Kentucky have used demonstration programs to restrict access to Medicaid by imposing work requirements.