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Medicaid: Legislation Needed to Improve Collections From Private Insurers

  Premium   Download PDF Now (36 pages)
Report Type Reports and Testimonies
Report Date Nov. 30, 1990
Report No. HRD-91-25
Subject
Summary:

Pursuant to a congressional request, GAO reviewed problems that state Medicaid agencies experienced in collecting from third parties, focusing on out-of-state insurers and employee health benefit plans covered under the Employee Retirement Income Security Act of 1974 (ERISA).

GAO found that: (1) states lacked jurisdiction over insurers that operated only incidentally in the state; (2) states' limited authority over ERISA plans did not allow them to prohibit those plans from certain actions to avoid payments for recipients' covered costs; (3) state officials could not easily identify Medicaid losses through their payment systems, but federal agency information indicated that the losses could be substantial and were likely to increase; and (4) to minimize future losses, states will need federal legislation to clarify Medicaid's role as payer of last resort and enhance their ability to collect from out-of-state insurers and ERISA plans.

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