Report Criticizes Lax Oversight of Medicaid Waiver Programs

The Bush administration has allowed states to make sweeping changes in the way care is delivered to elderly and disabled Medicaid recipients but has failed to monitor the quality of that care, according to a Congressional investigative report. The upshot is that some Medicaid patients are being neglected medically and physically, the New York Times reports.

The administration often boasts that it has approved record numbers of Medicaid "waivers," which exempt states from some federal regulations and give them wide latitude in changing Medicaid-covered services, including replacing nursing home care with so-called "home and community-based care."

But a report by the General Accounting Office (GAO) says that the Centers for Medicare and Medicaid Services (CMS) has not been monitoring the quality of care delivered under such waivers, as called for by law.

The GAO examined services provided to elderly people in 15 states where rather than pay the high cost of nursing home care, the states promised to provide a wide range of social and medical services in the patient''s home or community.

The GAO found problems with the quality of care in 11 of the 15 state waiver programs it examined. In many cases, Medicaid beneficiaries simply did not receive the services they were supposed to receive, and researchers found "medical and physical neglect" of some Medicaid recipients. But the "full extent" of the problem is unknown because "no one was enforcing basic safety and hygiene standards or systematically reviewing patients'' records," the Times reports. More than half the people receiving home and community care under Medicaid waivers are 65 or older.

"The report confirms what many Medicaid advocates have expressed as their major concern with the rush on the part of CMS to grant states waivers '” that the waivers are far more focused on saving money than improving, or even stabilizing, the health of the beneficiaries," says the National Senior Citizens Law Center.

"These waivers should be put on hold until the department gets a handle on the quality of care going to older and disabled Americans," said Sen. Charles E. Grassley (R-Iowa), who had requested the study. "Right now there''s no accountability, and that''s wrong."