The medicaid program is administered by the

Finally, state officials identified challenges with some federal reporting requirements, including concerns about whether certain reported data are useful for program oversight. Based on its prior work and the perspectives of others, GAO identified broader considerations for any potential federal actions to address these challenges, including tradeoffs and considerations related to the following:.

Medicaid—a joint federal-state health care financing program—is administered at the state level and overseen at the federal level by CMS. Since , GAO has designated Medicaid as a high-risk program due to concerns related to adequacy of fiscal oversight, among other concerns. The Medicaid program has evolved considerably in areas such as eligibility, service delivery, and payment methods. Given these and other changes to Medicaid over time, stakeholders have questions about the impact of the range and complexity of federal Medicaid policies on states' ability to efficiently administer their programs.

GAO was asked to assess a range of federal Medicaid policies. States are required to submit state plan amendments SPAs to CMS for review and approval prior to making program modifications. In addition to reviewing these SPAs, CMS works with state Medicaid agencies to review and approve applications for waivers of certain federal requirements.

Once states opt to participate in Medicaid, as all currently do, they are obligated to administer their programs within federal guidelines and requirements. The federal share for Medicaid administrative costs is generally 50 percent, but certain administrative functions receive a higher federal share. For example, upgrades to computer and data systems may be eligible for a 75 percent or 90 percent federal match if certain criteria are met. In recent years, state Medicaid program administration costs have grown at about the same rate as service costs and thus have remained a relatively constant share of total Medicaid spending, about 5 percent.

As part of their administrative responsibilities, both states and the federal government undertake a variety of program integrity activities to detect and deter fraud, waste, and abuse in Medicaid.

Ultimately these activities are intended to ensure that beneficiaries receive quality care and that taxpayer dollars are spent appropriately.