New CMS report fails to please critics of Medicaid waiver process

A new report to Congress on the transparency of Medicaid demonstration waivers is doing little to quell concerns that the CMS needs to beef up its oversight of the policy experiments.

Experts say the document fails fully explain how the federal government decides whether to approve or reject a state's application. 

“Given the significance of several demonstrations approved to date, this omission is striking,” said Sara Rosenbaum, a professor of health policy at George Washington University. 

The oversight of Medicaid's so-called 1115 waivers was the topic of two hearings this past summer and multiple Government Accountability Office reports. 

The waivers, which must be budget-neutral, allow states to experiment with Medicaid policy to improve services to beneficiaries. As of September 2015, there were 55 approved Section 1115 demonstration projects in operation in 38 states. They accounted for nearly one-third of all Medicaid expenditures In fiscal 2014, about $89 billion, up from one-fifth in fiscal 2011. 

“Critical Medicaid questions continue to be raised through the waiver process so this issue remains of utmost importance, and there are always ways in which the process could continue to improve” said Joan Alker, executive director of the Georgetown Center for Children and Families. 

The GAO, in reports dating back into the 1990s, has criticized the CMS process for approving state spending for demonstrations as opaque. The CMS also has failed to ensure the experiments don't add to Medicaid spending, according to the GAO. 

On Oct. 16, the CMS sent a report to Congress that was required by the Affordable Care Act as a means to ensure the public has notice, information and opportunity to provide input on the experimental approaches.