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GAO Calls for Transparency in Medicaid Waiver Demonstration Programs

The U.S. Government Accountability Office (GAO) called for greater transparency in Section 1115 Medicaid waiver demonstration programs in a May 13 report. Specifically, GAO makes the following recommendations to the U.S. Department of Health and Human Services (HHS):

  • Establish approval criteria for demonstration programs.
  • Document how demonstration programs promote the health of low-income populations.
  • Provide assurances in approval documentation that duplication of federal funding does not occur.

According to the report, HHS agreed, in part, with all recommendations made by GAO and will work to implement changes to the approval process. Specifically, HHS agreed to require states to ensure duplication of federal funding does not occur and will continue to evaluate applications based on existing federal funding criteria. HHS will also continue to identify in waiver approval documentation how each waiver program promotes the objectives of the Medicaid Program.

Medicaid demonstration programs are approved by HHS for five-year periods and can be renewed upon approval. Demonstration programs can cover a range of topics such as supplemental funding pools to extend health services, insurance subsidies to low-income populations, and increased access to care for vulnerable populations. These programs also give providers such as essential hospitals that predominantly serve the Medicaid and uninsured populations the ability to lead delivery system reform by improving care and investing in infrastructure to track and improve population health.

Contact Beth Feldpush, DrPH, senior vice president of policy and advocacy, at or 202.585.0111 with questions.


About the Author

Matt Buechner is the policy and advocacy associate for America's Essential Hospitals.

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