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Medicaid Demonstrations: Approvals of Major Changes Need Increased Transparency

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Report Type Reports and Testimonies
Report Date April 17, 2019
Release Date May 17, 2019
Report No. GAO-19-315
Summary:

About a third of Medicaid spending is for demonstrations, which allow states to test new approaches to delivering services. States and the federal government are supposed to be transparent about the demonstrations that are proposed and give the public a chance to weigh in. Is that happening?

The short answer is sometimes. Transparency has improved, but there are still significant gaps. For example, the federal government doesn't always require states to share the projected effects of proposals, even when they could significantly affect beneficiary eligibility.

We recommended ways for Medicaid to address these issues.

States that received a demonstration approval from January 2017 through May 2018

Map showing states that received demonstration approvals from January 2017 through May 2018

Map showing states that received demonstration approvals from January 2017 through May 2018

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