Medicaid

Data Improvements Needed to Help Manage Health Care Program Gao ID: IMTEC-93-18 May 13, 1993

Although high-quality data are needed to help manage the Medicaid program and to provide critical input to urgent national health care issues, the Health Care Financing Administration (HCFA) has done little to ensure the data's accuracy and completeness. Many studies have shown that the data states are reporting from their Medicaid information systems are often inaccurate, inconsistent, and incomplete. HCFA has not fixed these problems because it has not viewed resolution of data deficiencies to be a high priority. As a result, the lack of quality data has made it hard to determine how well people are being served by Medicaid.

GAO found that: (1) Medicaid data are often inaccurate, incomplete, and inconsistent; (2) HCFA has not required all states to supply certain data because it does not want to impose additional reporting requirements; (3) HCFA failure to collect quality Medicaid data prevents it from conducting sound program analyses, providing comprehensive information on emerging Medicaid and health care issues, and determining if program changes are accomplishing their objectives and people are obtaining appropriate and adequate medical services under the Medicaid program; (4) HCFA does not believe the resolution of programmatic data problems is a high priority; (5) HCFA has not sufficiently reviewed the quality of Medicaid data or informed states of their inaccurate and incomplete data because it believes it would infringe on the states' rights; (6) HCFA review of states' Medicaid management information systems does not include procedures to determine if the systems contain complete and accurate data; and (7) although HCFA has implemented some improvements to its state budget reports and Medicaid budget estimating process and developed a proposal to address data problems, its actions have not been sufficient to improve the quality of program data.

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.

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