Government Accountability OfficeCMS has challenged the GAO's report on Medicaid workrequirements, saying that GAO based its findings on just a fewstates and didn't determine whether CMS would allow thecosts.

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Some states have been eager to impose work requirements onpeople who get Medicaid, but thanks to a complete lack ofrequirements for cost projections, implementation of workrequirements is costing hundreds of millions ofdollars—not just inconsistent with federal control standards, butunder a complete lack of transparency.

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And, according to a newreport from the Government Accounting Office, thecosts don't include all planned expenditures.

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As the Wall Street Journal reports, CMS has allowed states to putnew requirements in place without also requiring states to estimatehow much they will cost. The administrative costs are not only nottransparent to the public, but also are not included incalculations designed to make sure they don't generate additionalfederal spending.

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Related: A work requirement for Medicaidisn't 'cruel'

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According to the GAO, "Without requiring states tosubmit projections of administrative costs in their demonstrationapplications, and by not considering the implications of thesecosts for federal spending, CMS puts its goals of transparency andbudget neutrality at risk. This is inconsistent with federalinternal control standards that call for agencies to identify,analyze, and respond to risks related to achieving programobjectives."

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CMS has no plans to change its process, despite the factor of"significant" administrative costs.

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CMS, for its part, challenged the report, saying that GAO basedits findings on just a few states and didn't determine whether CMSwould allow the costs.

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This study confirms that the Trump administration is allowingstates to waste taxpayer dollars in the pursuit of ideologicalchanges to Medicaid that hurt vulnerableAmericans," Senate Finance Committee ranking member Sen.Ron Wyden, D-OR, and House Energy and Commerce Committee ChairmanFrank Pallone Jr., D-NJ, said in a statement.

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According to the study, while nine states have already beenapproved to institute work requirements, another nine are awaitingapproval. Costs in states that have put such requirements in placerange from approximately $6 million in New Hampshire to $271million in Kentucky, with the federal government footing the billfor some 87 percent of Kentucky's costs.

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Other GAO reports on how states have changed Medicaid programshave also detailed problems, such as CMS's lack of requirements toestimate how many people might end up thrown off the Medicaid rollsin the event of work requirements. In Arkansas alone, workrequirements saw more than 18,000 people bumped from the programbefore a federal judge called a halt to the requirements.

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Marlene Satter

Marlene Y. Satter has worked in and written about the financial industry for decades.