WASHINGTON, DC – Today, Congressman Jim Jordan (R-OH), Ranking Member of the House Committee on Oversight and Reform, and Congressman Mark Meadows (R-NC) sent a letter to Centers for Medicare and Medicaid Services Administrator Seema Verma requesting information about how the agency oversees Medicaid managed care organizations (MCOs). Independent watchdogs have identified problems with MCOs, which states have increasingly used since the Patient Protection and Affordable Care Act (ACA).
Excerpts from the letter:
“According to the Government Accountability Office (GAO), federal spending for Medicaid managed care in 2017 comprised nearly half of all federal Medicaid expenditures-$171 billion.”
“While MCOs have the “potential to help states reduce Medicaid program costs,” government watchdogs have recently identified program integrity issues in Medicaid managed care.”
“A recent state audit of California’s Department of Health Care Services found the department made nearly $4 billion in “questionable” Medi-Cal payments between 2014 and 2017. According to the audit, approximately $3 billion of those payments stemmed from premiums paid to managed care plans. The audit attributed the questionable payments to “pervasive discrepancies” between state and county Medi-Cal beneficiary eligibility data.”
Full text of the letter can be viewed here.