What GAO Found
GAO’s analysis of Centers for Medicare & Medicaid Services (CMS) data in five selected states shows that the number and percentage of services delivered via telehealth and Medicaid beneficiaries receiving them increased exponentially at the beginning of the COVID-19 pandemic in March 2020. From March 2020 through February 2021, 32.5 million services were delivered via telehealth to about 4.9 million beneficiaries in the five states, compared with 2.1 million services to about 455,000 beneficiaries in the 12 months prior to the pandemic.
Percentage of Medicaid Beneficiaries Receiving at Least One of Their Services via Telehealth, March 2019 through February 2020 and March 2020 through February 2021
Note: GAO determined Tennessee’s data were not sufficiently reliable for purposes of this analysis.
Medicaid officials from all six selected states said expanding telehealth supported beneficiaries’ access to care, but also identified some limitations. Officials reported making or considering post-pandemic telehealth modifications.
CMS does not collect, assess, or report information about any effect delivering services via telehealth has on the quality of care Medicaid beneficiaries receive and has no plans to do so. Doing so is important, given concerns GAO has raised about the quality of care provided via telehealth. It would also be consistent with how CMS has encouraged states to use data on quality of care to identify disparities in health care and target opportunities for improvement to advance health equity. These efforts could begin with data for quality measures CMS already collects or through other means.
CMS neither agreed nor disagreed with GAO’s recommendations. GAO maintains it is crucial for CMS to collect and analyze information to assess telehealth’s effect on the quality of care Medicaid beneficiaries receive.
Why GAO Did This Study
To respond to the COVID-19 pandemic, states have expanded their coverage of telehealth in Medicaid, a jointly financed federal-state health care program for low-income and medically needy individuals.
The CARES Act includes a provision for GAO to report on the federal response to the pandemic. In addition, GAO was asked to examine the use of Medicaid flexibilities in response to COVID-19. This report describes selected states’ telehealth use before and during the pandemic, and experiences with and plans for telehealth. It also evaluates, among other things, CMS’s telehealth oversight of quality of services.
GAO analyzed state-reported data on telehealth use in six states selected, in part, based on variation in geography, Medicaid program size, and percentage of population living in rural areas. GAO reviewed federal oversight documents, interviewed state and federal Medicaid officials, and assessed CMS oversight against CMS guidance on using data to identify disparities in health care and target improvements.
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September 30, 2020The Department of Justice announced today that it has filed a lawsuit against Village Realty of Staten Island Ltd. and Denis Donovan, a sales and former rental agent at Village Realty, alleging discrimination against African Americans in violation of the Fair Housing Act when offering housing units for rent. The lawsuit is based on the results of testing conducted by the department’s Fair Housing Testing Program, in which individuals pose as renters to gather information about possible discriminatory practices.
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February 26, 2021Within the Department of Homeland Security (DHS), U.S. Immigration and Customs Enforcement (ICE) met its goal to expand the 287(g) program. However, ICE has not established performance goals that cover all program activities, such as ICE’s oversight of its law enforcement agency (LEA) partners, or measures to assess the program’s performance, such as the percentage of LEA partners in compliance with annual training requirements. As a result, ICE is not well-positioned to determine the extent to which the program is achieving intended results. ICE considers a number of factors, such as LEAs’ capability to act as an ICE force multiplier, when reviewing their suitability to join the program; however, ICE has not assessed how to optimize the use of its resources and program benefits to guide its recruitment of future 287(g) participants. For example, ICE has two models in which LEAs can participate with varying levels of immigration enforcement responsibilities. In the Jail Enforcement Model (JEM), designated state or local officers identify and process removable foreign nationals who have been arrested and booked into the LEA’s correctional facility, whereas in the Warrant Service Officer (WSO) model, the designated officers only serve warrants to such individuals. However, ICE has not assessed the mix of participants for each model that would address resource limitations, as each model has differing resource and oversight requirements. By assessing how to leverage its program resources and optimize benefits received, ICE could approach recruitment more strategically and optimize program benefits. 287(g) Participants in January 2017 and September 2020 ICE uses a number of mechanisms to oversee 287(g) JEM participants’ compliance with their agreements, such as conducting inspections and reviewing reported complaints. However, at the time of GAO’s review, ICE did not have an oversight mechanism for participants’ in the WSO model. For example, ICE did not have clear policies on 287(g) field supervisors’ oversight responsibilities or plan to conduct compliance inspections for WSO participants. An oversight mechanism could help ICE ensure that WSO participants comply with their 287(g) agreement and other relevant ICE policies and procedures. The 287(g) program authorizes ICE to enter into agreements with state and local law enforcement agencies to assist with enforcing immigration laws. The program expanded from 35 agreements in January 2017 to 150 as of September 2020. GAO was asked to review ICE’s management and oversight of the program. This report examines (1) the extent to which ICE has developed performance goals and measures to assess the 287(g) program; (2) how ICE determines eligibility for 287(g) program participation and considers program resources; and (3) how ICE conducts oversight of 287(g) program participant compliance and addresses noncompliance. GAO reviewed ICE policies and documentation, and interviewed officials from ICE headquarters and field offices. GAO also interviewed 11 LEAs selected based on the type of 287(g) agreement, length of participation, and facility type (e.g. state or local).While not generalizable, information collected from the selected LEAs provided insights into 287(g) program operations and oversight of program participants. GAO analyzed data on 287(g) inspection results and complaints from fiscal years 2015 through 2020. GAO recommends that ICE (1) establish performance goals and related performance measures; (2) assess the 287(g) program’s composition to help leverage its resources and optimize program benefits; and (3) develop and implement an oversight mechanism for the WSO model. DHS concurred with the recommendations. For more information, contact Rebecca Gambler at (202) 512-8777 or GamblerR@gao.gov.
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March 17, 2021What GAO Found Strengthening human capital management at federal agencies, particularly those with science and technology missions, can help agencies build a diverse, highly qualified, and agile workforce. GAO’s past work demonstrates three key areas for strengthening and sustaining the federal science and technology workforce. Strategic workforce planning to identify gaps and future needs. To successfully implement their missions, agencies need to identify current skill gaps and future needs in their workforce, and select the right human capital strategies to address them. However, GAO’s prior work has identified science and technology workforce strategic planning challenges that agencies have not fully addressed. For example, in October 2019, GAO evaluated major agencies’ implementation of cybersecurity workforce planning strategies for information technology (IT) workers. GAO found that most of the 24 federal agencies had not fully implemented five of the eight key workforce activities that GAO identified because of reasons such as competing priorities and limited resources. GAO recommended that the 18 agencies fully implement the eight key IT workforce planning activities. Thirteen agencies agreed with the recommendation, while the other five expressed a range of views; however, while some agencies have made progress, none have fully implemented the recommendation. Improving federal pay and hiring. Agencies may experience challenges in recruiting and retaining a diverse, highly-qualified workforce due to differences in pay compared to private sector employers and challenges related to the hiring process. Generally, federal agencies have seven broadly available government-wide special payment authorities to help address recruitment and retention challenges. In December 2017, GAO reported that the Office of Personnel Management (OPM) collects data on use of these authorities but had not analyzed how much the authorities help improve recruitment and retention. GAO also reported that the agency may be missing opportunities to promote strategic use of these authorities by providing guidance and tools on assessing effectiveness. Similarly, in August 2016, GAO reported that OPM and hiring agencies had not used hiring data to analyze the effectiveness of hiring authorities. Across these reports, GAO made six recommendations to assess and improve the use of pay and hiring authorities. OPM generally agreed with GAO’s recommendations, and has implemented two of the six recommendations, but has not fully implemented the other four. Addressing factors that affect the federal work environment. Factors affecting the working environment may also influence agencies’ ability to attract, hire, and retain personnel. For example, GAO reported in September 2020 that individuals who experience sexual harassment are more likely to leave their jobs. Also, in March 2015, GAO reported that impediments to interacting with non-federal scientific peers because, for example, of restrictions on conference participation can be a disincentive to federal employment. Agency officials told GAO that scientists and engineers establish their professional reputations by presenting research at conferences to have their work published and, without such opportunities, researchers may find federal employment less desirable. Addressing such factors could help agencies build and sustain a diverse, highly-skilled science and technology workforce. Why GAO Did This Study The federal workforce is critical to agencies’ ability to address the complex social, economic, and security challenges facing the United States. However, across government, mission critical skill gaps are undermining the ability of federal agencies to carry out their missions. Federal agencies face the difficult task of staying apace of advances in science and technology while competing for talent with the private sector, universities, and non-profit research centers. GAO has had long-standing concerns about federal agencies’ strategic human capital management, an issue highlighted in GAO’s High Risk Series since 2001. This testimony summarizes GAO’s insights based on a wide range of GAO work covering various human capital management- and science and technology-related issues from March 2015 through February 2021. In particular, the statement focuses on (1) workforce planning to help ensure agencies are better positioned to implement their missions; (2) opportunities and challenges to recruiting a diverse, high-qualified science and technology workforce; and (3) factors that can affect the work environment. For this testimony, GAO selected prior work across human capital management- and science and technology-related topics.
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