This presentation reviewed initial themes from expert interviews about the challenges of improving the transparency of Medicaid financing. The Medicaid statute permits states to raise the non-federal share of Medicaid expenditures through multiple sources, including state general revenue, health care-related taxes, and contributions from local governments. However, data are limited on the extent to which states rely on funding sources other than state general revenue.
The presentation reviewed MACPAC’s prior work on Medicaid financing, including past recommendations that the Centers for Medicare & Medicaid Services (CMS) collect provider-level data on the non-federal share of payments to hospitals and nursing facilities to enable analyses of net Medicaid payments to providers. These recommendations have not been implemented.
Barriers to improving the transparency of Medicaid financing identified from interviews so far include:
- unclear goals of additional transparency;
- incomplete information about state-level methods and amounts;
- multiple approaches that could be used to collect provider-level financing amounts; and,
- challenges using provider-level financing amounts to calculate net payments.