GAO Finds Oversight of Medicaid Waivers Lacking

July 10, 2003
A General Accounting Office (GAO) investigation finds that the Bush Administration has not held states accountable for the quality of care they provide to impoverished elderly and disabled people.

The GAO found that Secretary of Health and Human Services (HHS) Tommy G. Thompson has "not fully complied" with statutory requirements to monitor the quality of care under waivers that exempt states from certain federal regulations and give them broad discretion to decide who gets what services.

The GAO studied the care provided to 266,700 elderly people in 15 states and found that in many cases, Medicaid beneficiaries were not receiving the services they were entitled to. All of those studied were eligible for nursing-home care but chose to stay in the community with family and friends.

The states encouraged this community-based care, since it costs much less than nursing-home care, but in many cases failed to provide the support services the beneficiaries were entitled to.

HHS took no action to protect the patients from the state's negligence, the study found.

The GAO study was requested by Senators Charles Grassley (R-Iowa) and John Breaux (D-La.) They are proponents of community-based care but said they were alarmed by the GAO's findings.

"Right now there's no accountability," Grassley said. He and Breaux said any additional waivers should be put on hold until HHS "gets a handle on the quality of care." In a letter to Thompson, they asked the Bush Administration to submit a detailed plan for corrective action by July 28.

Thomas A. Scully, administration of HHS' Centers for Medicare and Medicaid Services, said he was "not aware of the extent of the problem."