News & Perspectives

GAO recommends improved Medicaid waiver evaluations

2. March 2018 Tom Entrikin Health

On February 20, 2018, the Government Accountability Office (GAO) released a report recommending changes in federal policies and procedures governing state-operated Medicaid demonstration waiver projects.  These projects represent the leading edge in state Medicaid innovation as well as over $109 billion in federal Medicaid spending annually. 

GAO found in its review of these projects that the Centers for Medicare and Medicaid Services (CMS) has not always demanded thorough, scientifically valid, and timely data evaluations as to whether the projects achieved state-specified, CMS-approved goals to improve care and to contain costs.  GAO also found that CMS had no written policy for making CMS-led data evaluations available quickly to the public.  GAO saw that as missing an opportunity to create a stronger empirical basis to inform federal and state Medicaid policy decision-making.

The GAO report acknowledges data availability, reliability, and cost issues that may complicate certain Medicaid waiver evaluations.  GAO also mentions appropriate steps that CMS has taken since 2014 to improve such evaluations.  Going forward, GAO recommends that CMS:

  • Establish written procedures for completing final evaluation reports at the end of each 3 to 5-year demonstration cycle, regardless of renewal status.
  • Issue criteria for when CMS may reasonably accept limited evaluations.
  • Adopt a policy for publicly releasing findings from CMS-led evaluations, including standards for timely release.


CMS has concurred with the GAO recommendations.  The GAO report is available here: