NE Washington News

A report from the Government Accountability Office (GAO) has highlighted issues with how the Centers for Medicare and Medicaid Services (CMS) enforces funding requirements under the Affordable Care Act, commonly known as Obamacare. The report, requested by Republicans on the Energy and Commerce Committee, indicates that CMS does not ensure that states fund state-mandated health insurance benefits without using federal taxpayer dollars.

The GAO report points out that while Obamacare mandates certain essential health benefits be covered by insurance plans in the individual market, states can mandate additional benefits. However, these states must cover the cost of such benefits without using federal funds like Advance Premium Tax Credits (APTCs). The report finds that CMS delegates oversight to the states instead of enforcing it directly. According to GAO, "CMS has limited assurance that APTCs accurately exclude the costs of non-EHB mandated benefits," raising concerns about potential improper federal spending.

Committee Chair Cathy McMorris Rodgers expressed concern over this issue. "This report, coupled with the immense Obamacare fraud this administration has overseen, highlights the need for Congress and the incoming administration to work swiftly to safeguard taxpayer funds at every corner of the agency," she said. She praised GAO's efforts in helping Congress address government waste and abuse.

The report details several key findings:

- CMS relies on states to enforce federal requirements themselves. The GAO noted: “States may require marketplace plans to cover items and services in addition to EHB; we refer to such benefits as non-EHB mandated benefits.”

- There are ongoing concerns within CMS regarding state compliance with funding their coverage mandates. For example, in recent Payment Notices from 2021 through 2023, CMS noted confusion among states about identifying non-EHB mandated benefits and ensuring premium data used for APTC calculations excluded these costs.

- One state was identified as incorrectly placing responsibility on CMS rather than itself for determining non-EHB mandated benefits.

- Uncertainty remains whether premium data appropriately excludes costs related to state-mandated benefits. The GAO concluded that "CMS does not know whether the premium data submitted by marketplace plans and used to calculate APTCs exclude the costs of non-EHB mandated benefits."

GAO recommends that CMS reassess its current oversight approach to better ensure federal funds are not improperly used for state-mandated health insurance benefits.