CMS needs to better oversee managed Medicaid programs, GAO says

The CMS isn’t doing enough to ensure that states are adequately paying managed Medicaid companies and that the plans are making correct payments to providers, according to a U.S. Government Accountability Office report released Thursday.

Medicaid enrollment in managed care increased by 56% from 2013 to 2016, jumping from covering 35 million beneficiaries to 54.6 million beneficiaries. Federal spending on services paid for under Medicaid managed care was $171 billion in 2017, almost half of the total federal Medicaid expenditures for that year.

But the CMS doesn’t have a process to track overpayments in managed care or determine whether states considered those overpayments when they set capitation rates, the GAO said.

“This lack of knowledge is of particular...