Sneak Preview: States Question Need for Required Medicaid Data

Jerry Ashworth
June 18, 2020 at 14:30:54 ET
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(The following was excerpted from a recent article in the Federal Grants Management Handbook.) Many state Medicaid officials explained that the program’s reporting requirements entail the collection of data that they contend “lacks relevance and usefulness,” according to a recent Government Accountability Office (GAO) report assessing state viewpoints on Medicaid program requirements.

In an informational report to congressional requestors, GAO interviewed Medicaid officials in all 50 states and the District of Columbia from June 2018 to April 2020 to assess their concerns and challenges related to program reporting requirements, waiver and demonstration processes, and other programmatic areas such as eligibility. GAO also obtained input from officials with the Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) and reviewed prior GAO work addressing the Medicaid program.

While they generally acknowledged the importance of federal Medicaid reporting requirements, state Medicaid officials from 48 states explained that these requirements can be “overly burdensome” (i.e., too costly, vague, complicated, paperwork-heavy, unnecessary or duplicative). Reports most often mentioned were: (1) the form CMS-64 quarterly expenditure report, which states use to report Medicaid expenditures to CMS for the purpose of determining federal funding; and (2) certain reports related to section 1115 demonstrations and section 1915(c) waivers such as the annual CMS-372(s) report, which states use to report financial and other information about these waivers.

“Officials from over half of the states highlighted a perceived lack of relevance or usefulness of some of the data states are required to report to CMS, expressed concerns about duplicative data requests or cited uncertainty about how CMS uses the data,” GAO found.

For example, some state officials questioned the need to report data on children’s screening services separately when CMS could obtain these data directly from CMS’ data collection system — the Transformed Medicaid Statistical Information System (T-MSIS) — which collects detailed claims and eligibility data from all states. They also asked how labor-intensive quarterly reports, such as the CMS-64 or section 1115 demonstration reports, were reviewed within CMS or used for program oversight.

(The full version of this story has now been made available to all for a limited time here.)

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