GAO: Medicaid’s Approach to Home Care Needs More Uniformity

Medicaid currently pays for personal care services through a patchwork of different waivers and other programs, with varying standards for ensuring that beneficiaries are kept safe and billing is above-board. This needs to change, according to a newly released report from the federal Government Accountability Office (GAO).

To compile its report, the GAO evaluated Medicaid-funded personal care in California, Maryland, Oregon, and Texas.

These states all have some safeguards in place to be sure that beneficiaries are receiving quality care and that billing practices are proper, the agency determined. However, there is variation among the states and sometimes within various programs in a single state.


“For example, to track attendants’ work time, two states required beneficiaries to sign paper timesheets for the attendants, and two states used electronic visit verification timekeeping systems for some or all programs,” the agency stated in a summary of its findings.

This lack of harmonization makes it more challenging for the federal government and states to monitor and manage home care, which is seeing a surge in demand, GAO noted.

The Centers for Medicare & Medicaid Services (CMS) can and should be doing more, the report recommended. For one, it should be collecting and analyzing information that states are required to gather for certain programs, such as the Community First Choice program. Also, CMS should take the steps that it can to harmonize requirements across these different Medicaid personal care services programs.


CMS concurred with the recommendations and noted that it already has taken some steps to achieve them. For example, it published a request for information in the Federal Register last month, seeking input on Medicaid home- and community-based services programs, including steps to ensure program integrity and beneficiary health.

Written by Tim Mullaney

Photo Credit: “Government Accountability Office Headquarters,” by kafka4prez, CC BY SA 2.0

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