#fiscal oversight

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Maryland’s TANF Shell Game: $833 Million Spent — Only 24% to Families

By MDBayNews Staff Credit: This article is based on reporting by Tessa Bentulan for Spotlight on Maryland, a collaboration between The Baltimore Sun and FOX45 News, published February 25–26, 2026. For years, Maryland politicians have claimed they are champions of the poor. They hold press conferences about “equity,” “uplift,” and “supporting working families.” But according to a new Spotlight…

Maryland’s TANF Shell Game: $833 Million Spent — Only 24% to Families

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Montgomery County Audit Finds Years of Lax Oversight in EMS Reimbursement Program

Montgomery County Audit Finds Years of Lax Oversight in EMS Reimbursement Program

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ADMINISTRATIVE CHALLENGES IN MEDICAID

Medicaid has been labeled as a high-risk government program by the GAO since 2003. The Medicaid program has struggled over the past seventeen years as a result of insufficient fiscal oversight and other administrative issues. These challenges will be exasperated as the program grows and enrollment surges in the course of the COVID-19 pandemic. If Medicaid is going to deliver on its goal to serve the health and wellness needs of our nation's most vulnerable low-income individuals and families, it is critical that these administrative problems be resolved.

In a recent report from the GAO, the agency assessed federal Medicaid policies, state perspectives on difficulties they experience due to current policies, and what federal government actions may be taken to address these challenges. After speaking with Medicaid officials from 50 states and Washington D.C., the GAO was able to identify federal policies, laws, and regulations that caused difficulty to effectively administer the Medicaid program.

Four problematic areas specified by administrative officials include coverage exclusions and care coordination, covered benefits and eligibility, Medicare and Medicaid alignment, and payment methods. Furthermore, Medicaid officials brought up reporting requirements and the lack of guidance. There is also much consternation due to the long delays when states are looking for approval to waive particular statutory Medicaid requirements. CMS is already in the process of addressing these problematic areas and has released updated guidance, streamlined the waiver process, and is working with stakeholders to design an updated reporting system.

Additionally, the GAO also found five relevant considerations that broadly apply to the reported areas of concern. The considerations include targeting federal oversight to critical areas, making use of program data, balancing oversight and flexibility for waivers and demonstrations, clarifying CMS policy, and responding to change.

KEY GAO CONSIDERATIONS

Targeting Federal Oversight To Crucial Areas

The GAO determined that program oversight activities must support beneficiary accessibility to benefits and the appropriate use of federal expenditures to protect against improper payments. This consideration was based off the GAO's report from March that estimated improper payments in the Medicaid program rose $21 billion in FY 2019. HHS stated that the surge was a result of inadequate documentation for eligibility determinations. Additionally, many improper payments resulted from noncompliance in screening and enrollment requirements.

Utilizing Medicaid Data

Poor quality data has been another issue for Medicaid plans in recent years. Incomplete and outdated data make program oversight extremely difficult. The report stated that "accurate and complete data on key measures-- such as measures for beneficiary access and use of services and the costs of providing such services-- are critical for oversight, including ensuring proper payments, and for informing any evaluation of policies." Reliable quality data could help show the cost-effectiveness of expanding Medicaid coverage to various other services. States and stakeholders concede that quality data will greatly aid in managing the Medicaid program.

Medicaid has been on the GAO's High-Risk List since 2003 as a result of poor oversight and various other administrative problems. Over the last seventeen years, program officials have struggled to administer Medicaid due to laws, policies, and regulations. If the program is to become fiscally solvent while properly coordinating care, improving fiscal oversight and accessing quality data is critical.

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