Improved Efforts Needed To Relieve Medicaid From Paying for Services Covered by Private Insurers

GAO reviewed six states' administration of Medicaid programs to assess the extent and effectiveness of their efforts to reduce Medicaid program costs by using other available health care resources. In addition, GAO described how state Medicaid practices for identifying and collecting private health insurance could be improved through more oversight by the Health Care Financing Administration (HCFA).

GAO found that: (1) when determining eligibility for Medicaid, three states asked only general questions about insurance resources; (2) in three other states, when recipients acknowledged having insurance coverage, caseworkers often failed to follow up and obtain the information necessary to use the insurance; (3) four states did not have ongoing programs to identify potential insurance coverage by computer-matching Medicaid files with other state data sources; (4) there was limited follow-up by the states to determine whether a liability insurer could be responsible for a claim; and (5) the Social Security Administration could help states better identify Medicaid recipient insurance resources by obtaining more insurance information for supplemental security income recipients. GAO also found that the administrative work involved in seeking recovery of Medicaid costs from liable insurers limits the amount states try to recover. Finally, GAO found that HCFA focuses its oversight of state practices related to recipient insurance resources on compliance reviews. These reviews have not identified some major weaknesses, and HCFA has not consistently gotten states to adopt the improvements which it suggested because there are no specific regulatory standards on how states should identify and use Medicaid recipients' insurance resources.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

Director: Michael Zimmerman Team: General Accounting Office: Human Resources Division Phone: (202) 275-6195