Administration's Medicaid Regulations: State-by-State Impacts. United States House of Representatives Committee on Oversight and Government Reform

摘要

On November 1, 2007, the Committee on Oversight and Government Reform held a hearing on regulations issued by the Centers for Medicare & Medicaid Services (CMS) that would make major, wide-ranging changes in federal Medicaid policy. In general, the seven regulations at issue represent unilateral actions by CMS neither directed nor authorized by Congress. The Committee heard testimony from the principal author of the regulations, Dennis Smith, the Director of the Centers for Medicaid and State Operations within CMS. According to the Administration, the regulations would reduce federal Medicaid payments to states by a total of more than $15 billion over the next five years. These estimates, like those issued at the time the regulations were published, are national in scope. They do not enable members of Congress or the public to assess the effect of the regulation on their own states. In a program like Medicaid, which is operated by the states on a day-to-day basis and is famous for its variation from state to state, the lack of state-specific estimates represents a major failure of transparency. Mr. Smith, who has lead responsibility for administering the Medicaid program at the federal level, did not present any estimates of the state-specific impact of the regulations, either at the hearing or in response to subsequent Committee requests.