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

And, according to a new report from the Government Accounting Office, the costs don't include all planned expenditures.

As the Wall Street Journal reports, CMS has allowed states to put new requirements in place without also requiring states to estimate how much they will cost. The administrative costs are not only not transparent to the public, but also are not included in calculations designed to make sure they don't generate additional federal spending.

According to the GAO, "Without requiring states to submit projections of administrative costs in their demonstration applications, and by not considering the implications of these costs for federal spending, CMS puts its goals of transparency and budget neutrality at risk. This is inconsistent with federal internal control standards that call for agencies to identify, analyze, and respond to risks related to achieving program objectives."

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

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

This study confirms that the Trump administration is allowing states to waste taxpayer dollars in the pursuit of ideological changes to Medicaid that hurt vulnerable Americans," Senate Finance Committee ranking member Sen. Ron Wyden, D-OR, and House Energy and Commerce Committee Chairman Frank Pallone Jr., D-NJ, said in a statement.

According to the study, while nine states have already been approved to institute work requirements, another nine are awaiting approval. Costs in states that have put such requirements in place range from approximately $6 million in New Hampshire to $271 million in Kentucky, with the federal government footing the bill for some 87 percent of Kentucky's costs.

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

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GAO hits Trump administration on costs of Medicaid work requirements

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