On April 26, the Government Accountability Office (GAO) released a report titled, "2017 ANNUAL REPORT: Additional Opportunities to Reduce Fragmentation,Overlap, and Duplication and Achieve Other Financial Benefits". It makes recommendations on ways to streamline executive branch agencies and functions by identifying areas where there is fragmentation, overlap, or duplication. It also identifies cost savings and revenue enhancement opportunities. Relevant to Medicaid are the following recommendations:
Medicaid Personal Care Services (p. 89): The GAO reports that in 2014, there was approximately $2 billion spent on improper payments for Medicaid personal care services. CMS manages two data systems that collect information from states on their Medicaid personal care services programs. A GAO report from January 2017 found that there were gaps and errors in the data collected between these two systems. The new report recommends that CMS improve data by establishing standard reporting guidance for key data, ensuring state compliance with reporting requirements, and developing plans to use data for oversight. The GAO says that improving data collection could result in the reduction of improper payments by tens of millions of dollars annually.
Disability Insurance (p. 95): The GAO report recommends increasing withholding rates of individuals' ongoing monthly DI benefit payments to allow for the recovery of tens of millions dollars annually in overpayments. Overpayments occur for many reasons, and the Social Security Administration (SSA) has a number of tools to recover those funds after they have been paid out. The current withholding rate is $10 per month, which was established in 1960. One possibility is to increase that amount to bring it more in line with the Supplemental Security Income (SSI) program. GAO had previously recommended adjusting the minimum monthly withholding rate to ten percent of DI benefits and consider adjusting the rate according to cost-of-living adjustments. To date, neither of those recommendations has been implemented.