Within that framework, states often use a variety of arrangements to  deliver services to their Medicaid populations, including traditional FFS,  PCCM and managed care. The state Medicaid agency is responsible for  administering the program, and the structure of how Medicaid services  are coordinated, administered, and delivered varies by state and  arrangement. Over 40 Percent of Medicaid Beneficiaries, Including Many with Disabilities, Were in Fee-for-Service Arrangements in 2014

CMS data show 41 percent of Medicaid beneficiaries nationwide were in  FFS arrangements in 2014, with wide variation among states; more  recent 2015 Medicaid Survey data suggest that millions remain in these  arrangements. 2014 Federal Data Show 41 Percent of Beneficiaries in Fee-for- Service, with Wide Variation among States; 2015 Medicaid Survey Data Suggest Millions Remain in These Arrangements

The most recent CMS data available show that 41 percent of about 71  million beneficiaries nationwide were served through FFS arrangements  as of July 1, 2014. Among states, the percentage of beneficiaries in FFS arrangements  varied widely, ranging from 0 to 100 percent (fig.1). In 22 states, the  majority of Medicaid beneficiaries were served through FFS  arrangements. However, the Medicaid Survey data also suggest that the proportion of  beneficiaries in FFS arrangements is declining, as states continue to  move populations from a FFS delivery model into managed care. According to Medicaid Survey data, of the 39 states with  managed care as of July 1, 2015, 6 had enrolled no aged or disabled  beneficiaries in managed care, and another 7 had enrolled fewer than  one-third of these beneficiaries. Children with special health care needs and certain other populations also  were more likely to be served through FFS arrangements, because states  were less likely to require or permit these populations to enroll in  managed care. A Few Federal Resources Exist to Help Fee-For-Service Beneficiaries Find Providers; Selected States’ Resources Vary

Although CMS and states consider the provision of resources to help  beneficiaries locate a provider to be primarily a state role, CMS has  provided a few resources to help beneficiaries. States Generally Have Resources to Help Beneficiaries Find a Provider, but Scope of Information and Availability of the Resources Varies

The 23 states we reviewed generally offered four common types of  resources—searchable provider directories, nonsearchable provider lists,  handbooks, and telephone helplines—to help beneficiaries in FFS  arrangements find a provider, with variation across states in the scope of  information they provided and how they addressed the needs of specific  Medicaid populations through their resources. 2). All of the 23 selected states had a publicly  available beneficiary handbook or brochure containing information about  the Medicaid program and operated a statewide telephone helpline that  allows beneficiaries to contact a Medicaid representative by telephone— either at the state Medicaid office or through a contractor—who can  answer questions and provide information on a variety of topics. The scope of information offered and the functionality of these common  resources varied:
Searchable provider directories: Seventeen of the 23 selected  states had online, searchable provider directories, and 16 of these  included provider information on specialty care physicians. Four of the  23 selected states’ searchable directories indicated whether providers  (primary or specialty care) were accepting new patients. Beneficiary telephone helplines: All states operated a helpline and  six operated outside of regular business hours. Medicaid officials we interviewed in four of the six states and  representatives from advocacy groups in three of the six states noted that  helplines are the primary resource beneficiaries use to report issues  finding a provider. When beneficiaries contact helplines, they can be  directed to additional resources—beyond those listed in the above  sections—to address their complaint. Agency Comments

We provided a draft of this report to HHS for comment. The department  provided technical comments, which we incorporated as appropriate.
Why GAO Did This Study

Medicaid is the federal and state health care program for low-income and medically needy individuals including certain children, adults, and aged and disabled individuals. As states transition more Medicaid enrollees and services to managed care, stakeholders have raised questions about populations that remain in FFS arrangements and the resources they can use to find health care providers. GAO was asked to provide information about Medicaid beneficiaries in FFS arrangements.
This report examines (1) the proportion and characteristics of Medicaid beneficiaries served in FFS arrangements, and (2) the federal and state resources available to help Medicaid beneficiaries in FFS arrangements find participating providers and report related challenges. GAO analyzed 2014 CMS data, the most recent available, on the proportion of Medicaid beneficiaries in different service delivery arrangements by state, and a 2015 survey of state Medicaid agencies by the Kaiser Commission on Medicaid and the Uninsured. GAO catalogued online, publicly available information from the 23 states having at least 30 percent of their Medicaid population in FFS arrangements, and confirmed the information via email or interview. GAO interviewed Medicaid officials and advocates in 6 of the 23 states and CMS officials. These states were selected, in part, based on the diversity of delivery system arrangements and resources. GAO also reviewed federal and state resources.
HHS provided technical comments on a draft of this report, which GAO incorporated as appropriate.

What GAO Found

According to the Centers for Medicare & Medicaid Services (CMS), as of July 2014, over 40 percent of nearly 71 million Medicaid beneficiaries were in fee-for-service (FFS) arrangements—traditional FFS and primary care case management—in which participating providers are paid for each delivered service (e.g., an office visit, test, or procedure). The percentage of beneficiaries in FFS arrangements varied widely among states—22 states served between 50 and 100 percent of beneficiaries, almost 16 million people, in FFS arrangements. A recent survey of states suggests that millions remained in FFS arrangements as of July 1, 2015. The survey also suggests that the proportion of beneficiaries in FFS arrangements is declining as states move more populations into risk-based managed care. Aged and disabled beneficiaries and children with special health care needs were the most likely of different Medicaid populations to be served through FFS arrangements instead of managed care.
CMS, the federal agency that oversees Medicaid, and states consider the development of resources to help beneficiaries find a provider to be a state role. CMS supports a federal resource for pediatric dental care and has provided guidance to states related to resources. The 23 states GAO reviewed have 4 common types of resources to help beneficiaries: searchable provider directories; nonsearchable provider lists; beneficiary helplines; and beneficiary handbooks. These resources vary with respect to the scope of information, availability, and states' adaptations to address beneficiary needs. Of the 23 states, GAO found the following:
17 had online, searchable provider directories; 16 of these included provider information on specialty care physicians and 4 indicated whether primary or specialty care providers were accepting new patients.
23 operated a helpline; 6 operated these outside of regular business hours.
9 included a mapping or location feature with their directories or lists.
Helplines are the primary resource that beneficiaries use to report issues finding a provider, according to Medicaid officials in 4 of 6 selected states and half of the advocacy group representatives GAO interviewed. When beneficiaries contact helplines, they can be directed to additional resources—beyond those listed above—to address their complaint.