Medicaid Beneficiaries Not Receiving Services

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Medicaid Beneficiaries Not Receiving Services

The federal government has allowed states to make widespread changes to Medicaid, but is not monitoring the quality of care provided or even if it is provided at all. Medicaid is the joint federal and state program that provides health services for low-income seniors and persons with disabilities.

According to Congressional investigators, the administration has approved a record number of Medicaid “waivers” that allow states to provide an array of alternatives to nursing home care that include home care, adult day care centers, and assisted living. While most seniors prefer to receive their care at home or in their communities, no one seems to be monitoring the care provided or, if it is provided at all. The waivers exempt states from some federal regulations and allow states, rather than the federal government, more power to decide who gets what services.

In 11 out of 15 of the largest waivers, the General Accounting Office (GAO) found problems with the quality of care. The most commonly cited problem — Medicaid beneficiaries did not receive the services they were supposed to get. In addition, the GAO found that states often failed to provide an adequate assessment of needs and case management. The problems cited by the GAO included failure to ensure that safety, nutrition, and hygiene standards were met, as well as cases of medical and physical neglect of beneficiaries. Neither the Centers for Medicare and Medicaid Services (CMS) nor the Department of Health and Human Services took action to protect beneficiaries, the report said.

CMS Administrator Thomas A. Scully said in an interview with The New York Times that he was “not aware of the extent of the problem.” He also said that states were responsible for “quality assurance.”

The GAO report, however, states that CMS regional offices are responsible for the ongoing monitoring of the waivers. The GAO said, “CMS is not fully complying with statutory and regulatory requirements when it renews waivers.”

Senators Charles E. Grassley (R-IA) and John B. Breaux (D-LA), who favor home and community-based care, requested the study but expressed alarm at the report findings. The Senators asked the administration to submit a detailed plan for corrective action.

Sources: “Report Criticizes Federal Oversight of State Medicaid,” Robert Pear, The New York Times, July 7, 2003. “Long-Term Care, Federal Oversight of Growing Medicaid Home and Community Based Waivers, ” General Accounting Office, June 2003, GAO-03-576.

October 2003