GAO: Feds need better data, better plan for national Medicaid database

This map from the Government Accountability Office shows which states were reporting data to T-MSIS as of November 2017.

Though nearly all states have begun reporting to Medicaid’s national data repository, the Government Accountability Office advised that the data sets must become more complete and officials must still formulate a clear plan for how to use them for oversight.

Those are among the findings of the GAO's new report (PDF), which reviewed states’ experience with and planned uses of the Transformed Medicaid Statistical Information System (T-MSIS).

The rollout of the data system has long been troubled, as technical challenges have forced its implementation deadline to be pushed back repeatedly. GAO’s latest report said 49 states had begun reporting T-MSIS data as of November—up significantly compared to the same time in 2016, when just 18 states were reporting.

But significant barriers stand in the way of the Centers for Medicare & Medicaid Services’ goal of using T-MSIS data for oversight of the Medicaid program. For example, none of the six selected states reporting T-MSIS data as of August 2017 were reporting complete data. As to why, the states said unreported elements were either not applicable to the Medicaid program or were contingent on federal or state actions.

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Even the data that states did provide proved difficult to report, with states saying that their biggest challenge was converting their data to the T-MSIS format on an element-by-element basis. States also had concerns about the comparability of T-MSIS data across states, and wanted CMS to facilitate information sharing so that they can accurately compare their T-MSIS data to that of other states.

Perhaps most importantly, CMS is not fully realizing important goals for T-MSIS—such as reducing states’ reporting burden and enhancing program integrity activities—because it doesn’t have a plan for how to use the system’s data for oversight. Recent increases in improper payments by the Medicaid program, which were estimated at $36.7 billion in fiscal year 2017, “exacerbate concerns about program oversight,” the report noted.

Thus, the GAO recommended that CMS both improve the completeness and comparability of T-MSIS data and articulate a specific plan to use that data for oversight of the Medicaid program. The report said that the Department of Health and Human Services agreed with the recommendations.