A federal watchdog found major lapses in the Department of Health and Human Services’ (HHS') response to the COVID-19 pandemic, specifically around testing and the distribution of critical supplies.
The congressionally mandated report, released Thursday, also recommended that Congress boost Medicaid payments to states to help them better handle an influx of beneficiaries.
The watchdog found that the need for critical supplies such as personal protective equipment (PPE) and ventilators quickly outpaced the stores in the Strategic National Stockpile. The distribution of supplies at the onset of the pandemic was based on guidance provided by HHS and the Federal Emergency Management Agency (FEMA).
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However, local officials have reported major lapses in coordination and challenges in getting supplies. For example, the National Governors Association blasted the federal response in April for a lack of coordination.
A survey of 213 mayors back in March also found that “most cities did not have and could not obtain adequate equipment and supplies such as test kits, face masks and ventilators,” the Government Accountability Office (GAO) said.
HHS’ Assistant Secretary for Preparedness and Response and FEMA told GAO that the views of the mayors and governors weren’t representative of the entire response effort. They added that state stockpiles were inadequate and that states overestimated their needs for supplies.
A task force led by HHS, Department of Defense and FEMA launched Project Air Bridge on March 29 to expedite the delivery of supplies. Trump administration officials have also said that an emphasis on domestic manufacturing will help the stockpile be replenished in time for a second surge in the fall.
GAO found that the government procured $2.1 billion for PPE and $3 billion for ventilators.
The watchdog also found major problems with the Centers for Disease Control and Prevention’s (CDC's) collection of testing data. CDC reported testing data that were not complete.
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“Initial delays in testing during the early pandemic stages have resulted in limited information on the spread of COVID-19 in communities, and the sources of testing data CDC has used have changed with changes in testing practices over time,” GAO said.
CDC hasn’t been counting the testing the same way. Back in May, the CDC posted guidance on how data “should be submitted to states from clinical laboratories, which are one source of laboratory data, but not all sources from which CDC has collected state data have provided consistent testing data.”
For instance, CDC sometimes collected and reported testing data from the states’ websites that aggregate testing data. However, some states’ websites count the number of people tested while others count the number of samples.
These inconsistencies led to unreliable information from the CDC on the amount of viral testing occurring over time. This has complicated efforts to determine the infection rate and inform decisions on reopening states, GAO found.
But the watchdog was hopeful the CDC can turn it around as it put out guidance on June 4 requiring all labs to submit data so the agency doesn’t have to get the information from states.
The agency also gave recommendations for how to help states by boosting the Federal Medicaid Assistance Percentages (FMAP), which is the formula where the federal government matches states’ spending on services.
“We found that during economic downturns—when Medicaid enrollment can rise and state economies weaken—the FMAP formula, which is based on each state’s per capita income, does not reflect current state economic conditions,” the GAO said. “In addition, past efforts to provide states with temporary increases in the FMAP were not as timely or responsive as they could have been.”
HHS did provide $7 billion in Medicaid funding via a temporary increase in the FMAP.
GAO previously had recommended that Congress should pass legislation creating a new formula that can quickly boost Medicare matching payments during a major economic downturn. The formula would trigger based on a rapid change in state employment data.