WASHINGTON, DC - The Subcommittee on Health, chaired by Rep. Joe Pitts (R-PA), today held a hearing to discuss the administration’s approval of Medicaid demonstration projects. A recent report from the nonpartisan Government Accountability Office raised concerns about the lack of transparency and accountability in the administration’s spending on Medicaid programs.
“Medicaid is a lifeline for some of our nation’s most vulnerable patients," said Pitts. “The Administration and Congress have a duty to ensure that taxpayer dollars used for Medicaid are spent in a manner that promotes its core objectives and helps our neediest citizens."
Full Committee Chairman Fred Upton (R-MI) added, “This subcommittee will play its role in making the process more transparent, accountable, and fair for all involved. At the end of the day - it’s about ensuring our most vulnerable receive the care they deserve."
Rep. Michael C. Burgess, M.D. (R-TX) and Katherine Iritani, Director of Health Care at the GAO, discussed the administration’s lack of transparency and clarity for determining criteria of the approval process for Medicaid spending. Ms. Iritani explained, “[CMS] officials told us that it wasn’t within the Secretary’s interest to have written criteria."
Watch the exchange here:
Click to watch Rep. Burgess and Ms. Iritani’s exchange
Members and witnesses discussed ways to improve the administration’s approval process of demonstration programs, reform the Medicaid program overall, and improve transparency.
“Because so many important decisions about Medicaid policy and financing are made through the waiver process I believe that it is vitally important that there be a robust process for public comment and input at both the state and federal levels," said Joan Alker, executive director of Georgetown University’s Center for Children and Families. “Many important documents, such as operational protocols, quarterly and annual reports, and other significant deliverables required in Section 1115 special terms and conditions, are not publicly available on Medicaid.gov, and I would recommend that those be made publicly available as soon as possible."
Rep. Gus Bilirakis (R-FL) and former Mississippi Governor Haley Barbour discussed the option for Congress to create a process where longstanding core elements of an 1115 waiver can be effectively grandfathered into the state’s plan amendment. “I think that’s absolutely a step in the right direction. If you’ve got a demonstration project that has demonstrated that it works… it shouldn’t be years and years and years later… at some point you ought to just able to make that permanent," said Barbour. “We (states) are the laboratories of democracy. If Florida’s got something that really works, it ought to be easier for us to go adopt what Florida’s doing, make some adjustments for us… if we choose to, and not have to go through a big long process that takes 337 days."
“If we can make the waiver process less necessary, if we can build some of those common sense developments into the underlying program, we can free up resources that can really be focused on real innovation," said Matt Salo, executive director at the National Association of Medicaid Directors. “The system has to be accommodating to thinking outside of the box."
Read full witness testimony HERE.
