GAO: Gaps Remain in Medicaid Managed Care Direct Payments Oversight

Health Payer Intelligence June 29, 2022
Kelsey Waddill

CMS has made changes to its data collection processes for Medicaid managed care direct payments, but there is still room for improvement, according to GAO.

Despite CMS efforts to expand oversight of Medicaid managed care direct payments and the US Government Accountability Office’s (GAO’s) previous recommendations to improve processes, the direct payment process in Medicaid still suffers from missing information, according to a GAO report.

Typically, states fund managed care plans and these plans cover providers’ services. However, CMS allows direct managed care plan payments to providers, or state directed payments, that are based on state-determined quality measures.

CMS provides some oversight for these state directed payments, but when GAO reviewed CMS data, documents, and guidance and interviewed...

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