Introducing Oversight Overview: Medicaid Oversight Committees

This month, the State Oversight Academy launches a new video series called Oversight Overview that explores how state legislatures across the nation are performing oversight of a particular issue. Bipartisan, fact-based oversight is the duty of state legislatures, and although factors such as political climate, term limits, and rotating committee assignments can make it difficult to achieve, there are smaller steps that can improve this legislative function. Ensuring that oversight committees are joint and bipartisan, have well-defined jurisdictions and authorities, and promote transparency will help ensure that investigations focus on finding facts and solving problems rather than political posturing.

Our first Oversight Overview explores Medicaid oversight, traveling to four statehouses – Iowa, Louisiana, North Carolina, and Ohio. You can watch the video here.

The Iowa Joint Health Policy Oversight Committee was established in 2015 to “[p]rovide continuing oversight for Medicaid managed care, ensure effective and efficient administration of the program, address stakeholder concerns, monitor program costs and expenditures, and make recommendations to the General Assembly.” It has met at least once/year since its creation, usually taking testimony from the Department of Human Services, Department of Human Rights, Legislative Services Agency, and Department of Public Health.

At 60% Republican, the committee’s membership is more bipartisan than the full General Assembly, which is 65.3% Republican. However, its jurisdiction is not well-defined, and the Iowa General Assembly does not specify committee oversight authorities in its rules. The committee’s website includes a good deal of information, including membership; meeting schedules, agendas, minutes, and archived video; and public comments, presentations, and other committee documents.

The Louisiana Joint Medicaid Oversight Committee was established in 2020 so that the assigned legislators could learn the complexities of the program, which makes up almost half of the state’s budget, and improve oversight. The jurisdiction is well-defined, instructing the authority to “monitor, review, and make recommendations,” “[r]eview the compliance of the Louisiana Department of Health,” and “[p]lan, advertise, organize, and conduct forums, conferences, and other meetings, in which representatives of state agencies and other individuals with expertise in the state Medicaid program may participate, to increase knowledge and understanding of and to develop and propose improvements to the state Medicaid program.” The committee can hold hearings, “require the production of books and records,” and “may call upon the staffs of any department, agency, or official of the state…for data and assistance.”

The committee, which is 66.7% Republican, is slightly more bipartisan than the full legislature, at 68.1% Republican. Though the jurisdiction and authority are clear, transparency is lacking – only membership is listed on the committee’s website.

North Carolina’s Joint Legislative Oversight Committee on Medicaid and NC Health Care is responsible for examining “budgeting, financing, administration, and operational issues related” to the programs. The committee gain can “access to any paper or document and may compel the attendance of any State official or employee before the Committee or secure any evidence” and can also issue subpoenas. It receives reports from the Department of Health and Human Services throughout the session, and DHHS is required to send a copy of any report to the General Assembly or committee to the cochairs of the Medicaid Oversight Committee.

The committee’s website promotes transparency by hosting a wealth of information, including membership, bills in committee, reports to the General Assembly, reports to the committee, meeting agendas and presentations, and subcommittee information. However, the committee is more partisan (80% Republican) than the full General Assembly, which is 60% Republican.

Finally, the Ohio General Assembly established the Joint Medicaid Oversight Committee in 2014 to continuously oversee the state’s Medicaid program. The committee’s responsibilities include ensuring Medicaid compliance aligns with legislative objectives, assessing the long-term effects of legislation on Medicaid, and aiding in controlling spending growth while enhancing the quality of care and health outcomes for Medicaid beneficiaries in the state. Apart from possessing subpoena power, the committee and its staff are authorized to conduct unannounced inspections of Medicaid offices within state and local governments. It has met about once per month since its establishment, requiring regular reports from the Department of Medicaid on issues including access barriers, program participation, and the needs of low-income pregnant women and children. The State Auditor provides reports to the committee upon request.

The committee has produced multiple reports of its own, which are available on its website, along with its membership and meeting dates, notices, minutes, and related materials. With a 60% Republican composition, the committee demonstrates greater bipartisanship compared to the entire General Assembly, where Republicans make up 70% of the membership.

These four Medicaid oversight committees all possess some of the traits that enhance effective, fact-based oversight, but there is room for improvement. Increasing bipartisanship and transparency, defining a clear jurisdiction, and prescribing appropriate investigatory powers promotes better oversight, not just of Medicaid, but all issues facing legislative bodies.

Is your committee practicing effective, fact-based oversight? The State Oversight Academy is happy to assess or assist! Contact us today.

Download the video’s accompanying document here.