Medicaid: Intergovernmental Transfers Have Facilitated State Financing Schemes

Testimony issued by the General Accounting Office with an abstract that begins "Medicaid, the federal-state health financing program for many of the nation's most vulnerable populations, finances health care for an estimated 53 million lowincome Americans, at a cost of $244 billion in 2002. Congress structured Medicaid as a shared fiduciary responsibility of the federal government and the states, with the federal share of each state's Medicaid payments determined by a formula specified by law. In 2002, the federal share of each state's expenditures ranged from 50 to 76 percent under this formula; in the aggregate, the federal share of total Medicaid expenditures was 57 percent. Some states have used a number of creative financing schemes that take advantage of statutory and regulatory loopholes to claim excessive federal matching payments. GAO was asked to summarize prior work on how some of these schemes operated, including the role of intergovernmental transfers (IGT), which enable government entities--such as the state and local-government facilities like county nursing homes--to transfer funds among themselves. GAO was also asked to discuss these schemes' effects on the federalstate Medicaid partnership and to discuss what can be done to curtail them.