Dive Brief:

• Implementing controversial work requirements in five states cost taxpayers nearly $408 million, according to a government watchdog report analyzing administrative costs over a three-year period.
• The Government Accountability Office raised concerns about a lack of oversight regarding the administrative costs. The report warns some of the costs may not be allowable under CMS guidance. In one case, the costs in question have already amounted to tens of millions of dollars.  
• The GAO issued a series of recommendations, including recommending making administrative costs available to the public. But CMS didn't agree with the recommendations, according to the report.  

Dive Insight:

President Donald Trump's administration has continued to back Medicaid work requirements that tie access to coverage to employment. 

However, the requirements have hit snags in the courts as judges have blocked or struck down their implementation. 

Since January 2018, the administration has approved demonstration waivers, or applications, from nine states. 

The GAO report examined the administrative costs to implement the work requirements in five states, which were the first to receive approval from federal regulators. 

The administrative costs for each state varied significantly from $6 million to more than $270 million. In each instance, the federal government bears the majority of those costs, according to GAO's estimates. 

States aren't required to provide estimates on how much it will cost to implement the work requirements. This means the agency doesn't have the information to consider in determining whether the demonstrations are budget neutral, the report said.  

The GAO report called for states to provide such cost projections. CMS should also assess its risk of providing funds that may not be allowed under CMS guidance and improve oversight, the report said. 

Andy Slavitt, who headed up CMS under former President Barack Obama, said it was costing millions to take care away from Americans. 

"More money, fewer people with care. And you paid for 87% of it!" Slavitt tweeted following the release of the report.