Medicaid: Information on the Use of Electronic Asset Verification to Determine Eligibility for Selected Beneficiaries

What GAO Found

Individuals who receive assistance from the federal Supplemental Security Income (SSI) program may also become eligible for Medicaid. SSI provides cash assistance to eligible individuals who are over age 65, blind, or disabled; and who have limited resources (i.e., assets) and income. Medicaid programs in 42 states and the District of Columbia use the SSI asset limit of $2,000 for an individual or $3,000 for a married couple. Medicaid programs in the remaining eight states may set an asset limit that differs from the current SSI asset limit.

The Social Security Administration (SSA), which administers the SSI program, and state Medicaid programs electronically verify the assets of these individuals when determining financial eligibility:

  • In the 42 states and the District of Columbia that use the SSI asset limit, SSA is the entity that verifies applicants’ assets. SSA has two data sources to detect assets among SSI beneficiaries. The first data source is the Access to Financial Institutions initiative. This initiative verifies reported bank accounts and can detect potential undisclosed accounts from financial institutions within geographic proximity of an SSI recipient’s residence. The second data source is Non-home Real Property, which uses a commercial data source to help investigate potential ownership of real property other than a primary residence.
  • In the eight states that may set their own asset limits, the state’s Medicaid program must verify Medicaid eligibility for SSI recipients using an electronic asset verification system (AVS). An AVS provides a portal between state eligibility systems and banks or other third-party systems with electronic access to financial information. Once a state has an AVS in place, state eligibility workers can submit a request through the portal to perform an asset check for a Medicaid applicant. The request is sent to different financial institutions. A vendor gathers the information from the financial institutions and returns it to the state, and eligibility workers use the information to make an eligibility determination. Some states also use their AVS to check on applicants’ property information, which may come from commercial data sources.

Why GAO Did This Study

GAO was asked to review the use of electronic asset verification to determine eligibility for selected Medicaid beneficiaries. This report provides an overview of what is known about how state Medicaid programs verify assets of applicants who are eligible because they receive SSI, and how SSA verifies assets of SSI applicants, among other issues.

To describe what is known about how state Medicaid programs and SSA verify applicants’ assets, GAO reviewed its prior work, as well as related research by other organizations. GAO also obtained input from officials from the Centers for Medicare & Medicaid Services and SSA; and reviewed relevant federal laws, regulations, and guidance. The Department of Health and Human Services and SSA reviewed a draft of this report and provided technical comments, which GAO incorporated as appropriate.

For more information, contact Carolyn L. Yocom at (202) 512-7114 or yocomc@gao.gov.

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    GAO reported in June 2020 that, of the 15 major Department of Defense (DOD) information technology (IT) programs selected for review, 11 had decreased their cost estimates as of December 2019. The decreases in cost estimates ranged from a .03 percent decrease to a 33.8 percent decrease. In contrast, the remaining four programs experienced increases in their life-cycle cost estimates—--two with increases exceeding 20 percent. Program officials reported several reasons for the increases, including testing delays and development challenges. Ten of the 15 programs had schedule delays when compared to their original acquisition program baselines. Schedule delays ranged from a delay of 1 month to a delay of 5 years. Program officials reported a variety of reasons for significant delays (delays of over 1 year) in their planned schedules, including cyber and performance issues. Regarding software development, officials from the 15 selected major IT programs that GAO reviewed reported using software development approaches that may help to limit risks to cost and schedule outcomes. For example, 10 of the 15 programs reported using commercial off-the-shelf software, which is consistent with DOD guidance to use this software to the extent practicable. Such software can help reduce software development time, allow for faster delivery, and lower life-cycle costs. In addition, 14 of the 15 programs reported using an iterative software development approach which, according to leading practices, may help reduce cost growth and deliver better results to the customer. However, programs also reported using an older approach to software development, known as waterfall, which could introduce risk for program cost growth because of its linear and sequential phases of development that may be implemented over a longer period of time. Specifically, two programs reported using a waterfall approach in conjunction with an iterative approach, while one was solely using a waterfall approach. With respect to cybersecurity, programs reported mixed implementation of specific practices, contributing to program risks that might impact cost and schedule outcomes. For example, all 15 programs reported developing cybersecurity strategies, which are intended to help ensure that programs are planning for and documenting cybersecurity risk management efforts. In contrast, only eight of the 15 programs reported conducting cybersecurity vulnerability assessments—systematic examinations of an information system or product intended to, among other things, determine the adequacy of security measures and identify security deficiencies. These eight programs experienced fewer increases in planned program costs and fewer schedule delays relative to the programs that did not report using cybersecurity vulnerability assessments. For fiscal year 2020, DOD requested approximately $36.1 billion for IT investments. Those investments included major IT programs, which are intended to help the department sustain key operations. The National Defense Authorization Act for Fiscal Year 2019 included a provision for GAO to assess selected IT programs annually through March 2023. GAO's objectives for this review were to, among other things, (1) describe the extent to which selected major IT programs have changed their planned costs and schedules since the programs' initial baselines; and (2) describe what selected software development and cybersecurity risks or challenges, if any, may impact major IT programs' acquisition outcomes. GAO selected programs based on DOD's list of major IT programs, as of April 10, 2019. From this list, GAO identified 15 major IT programs that had established an initial acquisition program baseline and that were not fully deployed by December 31, 2019. GAO compared the 15 programs' initial cost and schedule baselines to current acquisition program estimates. In addition, GAO aggregated DOD program office responses to a GAO questionnaire about software development approaches and cybersecurity practices used by the 15 programs. GAO compared this information to leading practices to identify risks and challenges affecting cost, schedule, and performance outcomes. This report is a public version of a “for official use only” report issued in June 2020. For more information, contact Kevin Walsh at (202) 512-6151 or walshk@gao.gov.
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  • Texas Entrepreneur Charged with Spending COVID Relief Funds on Improper Expenses Including Lamborghini and Strip Club
    In Crime News
    A Houston, Texas man has been taken into custody on allegations he fraudulently obtained more than $1.6 million in Paycheck Protection Program (PPP) loans, announced Acting Assistant Attorney General Brian C. Rabbitt of the Justice Department’s Criminal Division and U.S. Attorney Ryan K. Patrick of the Southern District of Texas.
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  • The Nation’s Fiscal Health: Effective Use of Fiscal Rules and Targets
    In U.S GAO News
    In fiscal year 2019, debt held by the public reached 79 percent of gross domestic product (GDP). The government's fiscal response to COVID-19 combined with the severe economic contraction from the pandemic will substantially increase federal debt. The Congressional Budget Office (CBO) projected that debt held by the public will reach 98 percent of GDP by the end of fiscal year 2020. The nation's fiscal challenges will require attention once the economy has substantially recovered and public health goals have been attained. GAO has previously reported that a long-term plan is needed to put the government on a sustainable fiscal path. Other countries have used well-designed fiscal rules and targets—which constrain fiscal policy by controlling factors like expenditures or revenue—to contain excessive deficits. For example, Germany's constitution places limits on its deficits. The U.S. federal government has previously enacted fiscal rules, such as those in the Budget Control Act of 2011. However, current fiscal rules have not effectively addressed the misalignment between spending and revenues over time. GAO identified key considerations to help Congress if it were to adopt new fiscal rules and targets, as part of a long-term plan for fiscal sustainability (see table). Key Considerations for Designing, Implementing, and Enforcing Fiscal Rules and Targets Setting clear goals and objectives can anchor a country's fiscal policy. Fiscal rules and targets can help ensure that spending and revenue decisions align with agreed-upon goals and objectives. The weight given to tradeoffs among simplicity, flexibility, and enforceability depends on the goals a country is trying to achieve with a fiscal rule. In addition, there are tradeoffs between the types and combinations of rules, and the time frames over which the rules apply. The degree to which fiscal rules and targets are binding, such as being supported through a country's constitution or nonbinding political agreements, can impact their permanence, as well as the extent to which ongoing political commitment is needed to uphold them. Integrating fiscal rules and targets into budget discussions can contribute to their ongoing use and provide for a built-in enforcement mechanism. The budget process can include reviews of fiscal rules and targets. Fiscal rules and targets with limited, well-defined exemptions, clear escape clauses for events such as national emergencies, and adjustments for the economic cycle can help a country address future crises. Institutions supporting fiscal rules and targets need clear roles and responsibilities for supporting their implementation and measuring their effectiveness. Independently analyzed data and assessments can help institutions monitor compliance with fiscal rules and targets. Having clear, transparent fiscal rules and targets that a government communicates to the public and that the public understands can contribute to a culture of fiscal transparency and promote fiscal sustainability for the country. Source: GAO analysis of literature review and interviews. | GAO-20-561 Our nation faces serious challenges at a time when the federal government is highly leveraged in debt by historical norms. The imbalance between revenue and spending built into current law and policy have placed the nation on an unsustainable long-term fiscal path. Fiscal rules and targets can be used to help frame and control the overall results of spending and revenue decisions that affect the debt. GAO was asked to review fiscal rules and targets. This report (1) assesses the extent to which the federal government has taken action to contribute to long-term fiscal sustainability through fiscal rules and targets, and (2) identifies key considerations for designing, implementing, and enforcing fiscal rules and targets in the U.S. GAO compared current and former U.S. fiscal rules to literature on the effective use of rules and targets; reviewed CBO reports and relevant laws; and interviewed experts. GAO conducted case studies of national fiscal rules in Australia, Germany, and the Netherlands. Congress should consider establishing a long-term fiscal plan that includes fiscal rules and targets, such as a debt-to-GDP target, and weigh GAO's key considerations to ensure proper design, implementation, and enforcement of these rules and targets. The Department of the Treasury and other entities provided technical comments, which GAO incorporated as appropriate. For more information, contact Jeff Arkin, at (202) 512-6806 or arkinj@gao.gov.
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  • Consumer Privacy: Better Disclosures Needed on Information Sharing by Banks and Credit Unions
    In U.S GAO News
    Banks and credit unions collect, use, and share consumers' personal information—such as income level and credit card transactions—to conduct everyday business and market products and services. They share this information with a variety of third parties, such as service providers and retailers. The Gramm-Leach-Bliley Act (GLBA) requires financial institutions to provide consumers with a privacy notice describing their information-sharing practices. Many banks and credit unions elect to use a model form—issued by regulators in 2009—which provides a safe harbor for complying with the law (see figure). GAO found the form gives a limited view of what information is collected and with whom it is shared. Consumer and privacy groups GAO interviewed cited similar limitations. The model form was issued over 10 years ago. The proliferation of data-sharing since then suggests a reassessment of the form is warranted. Federal guidance states that notices about information collection and usage are central to providing privacy protections and transparency. Since Congress transferred authority to the Consumer Financial Protection Bureau (CFPB) for implementing GLBA privacy provisions, the agency has not reassessed if the form meets consumer expectations for disclosures of information-sharing. CFPB officials said they had not considered a reevaluation because they had not heard concerns from industry or consumer groups about privacy notices. Improvements to the model form could help ensure that consumers are better informed about all the ways banks and credit unions collect and share personal information. Excerpts of the Gramm-Leach-Bliley Act Model Privacy Form Showing Reasons Institutions Share Personal Information Federal regulators examine institutions for compliance with GLBA privacy requirements, but did not do so routinely in 2014–2018 because they found most institutions did not have an elevated privacy risk. Before examinations, regulators assess noncompliance risks in areas such as relationships with third parties and sharing practices to help determine if compliance with privacy requirements needs to be examined. The violations of privacy provisions that the examinations identified were mostly minor, such as technical errors, and regulators reported relatively few consumer complaints. Banks and credit unions maintain a large amount of personal information about consumers. Federal law requires that they have processes to protect this information, including data shared with certain third parties. GAO was asked to review how banks and credit unions collect, use, and share such information and federal oversight of these activities. This report examines, among other things, (1) what personal information banks and credit unions collect, and how they use and share the information; (2) the extent to which they make consumers aware of the personal information they collect and share; and (3) how regulatory agencies oversee such collection, use, and sharing. GAO reviewed privacy notices from a nongeneralizable sample of 60 banks and credit unions with a mix of institutions with asset sizes above and below $10 billion. GAO also reviewed federal privacy laws and regulations, regulators' examinations in 2014–2018 (the last 5 years available), procedures for assessing compliance with federal privacy requirements, and data on violations. GAO interviewed officials from banks, industry and consumer groups, academia, and federal regulators. GAO recommends that CFPB update the model privacy form and consider including more information about third-party sharing. CFPB did not agree or disagree with the recommendation but said they would consider it, noting that it would require a joint rulemaking with other agencies. For more information, contact Alicia Puente Cackley at (202) 512-8678 or CackleyA@gao.gov or Nick Marinos at (202) 512-9342 or MarinosN@gao.gov.
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  • Justice Department Issues Statement Announcing Decision to Appeal Alabama Association of Realtors v. HHS
    In Crime News
    Brian M. Boynton, Acting Assistant Attorney General for the Justice Department's Civil Division, released the following statement:
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    In Travel
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  • CEO of Financial Firm Pleads Guilty to Running Multi-Million Dollar Securities and Tax Fraud Scheme, and Operating an Unlicensed Money Services Business
    In Crime News
    A California-based man pleaded guilty today to conspiring with others to defraud shareholders of publicly traded companies, transmitting millions of dollars through the operation of an unlicensed money-services business in California, and falsifying multiple years of federal tax returns.
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  • Briefing with European and Eurasian Affairs Acting Assistant Secretary Philip T. Reeker on the Secretary’s Upcoming Travel to Belgium
    In Crime Control and Security News
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  • Florida Recording Artist and Pennsylvania Man Charged for Role in $24 Million COVID-Relief Fraud Scheme
    In Crime News
    A Florida recording artist and a Pennsylvania towing company owner have been charged for their alleged participation in a scheme to file fraudulent loan applications seeking more than $24 million in forgivable Paycheck Protection Program (PPP) loans guaranteed by the Small Business Administration (SBA) under the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
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  • U.S. Vote Against the United Nations 2021 Program Budget
    In Crime Control and Security News
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  • Designation of Iraqi Militia Leader in Connection with Serious Human Rights Abuse
    In Crime Control and Security News
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