what he thinks republicans lost the house. then, washington post opinion writer joins us to talk about the midterm election result in his book. come out upcoming lame-duck congressional session, and this week's house gop leadership elections. be sure to watch c-span's washington journal live at 7 a.m. monday morgan -- monday morning. join the discussion. >> c-span, where history unfolds daily. it in 1979, c-span was created as a public service by america's cable television companies. and today, we continue to bring you unfiltered coverage of congress, the white house, the policy court, and public events in washington dc and around the country. c-span is brought to you by your cable or satellite provider. "washington journal"

continues. host: each week in this segment we take a look at how your money is at work in a different federal program. this week we are focusing on the medicaid program, and to do that we are joined by the government accountability office's health care director, carolyn yocom. we will talk about medicaid expansion and the costa states and the federal government. remind us how medicaid was expanded under the affordable care act, who became eligible for inclusion under the expansion. guest: the category of people who are now eligible for medicaid who were not before our nonelderly, nondisabled adults. medicaid had always traditionally covered children, people with disabilities and those who are elderly. so that is the new population. host: how many states have taken medicaid expansion? guest: about 37 right now. host: what does that translate to in terms of number of new people who are being covered under medicaid?

guest: it is up around 70 million, up to 70 million right now. host: what is the cost right now of medicaid per year? guest: right now come adults in the medicaid program are about 50% of the cost. the medicaid expansion component is 10%, because there were some adults already covered by states who had chosen to do so. host: what does that translate to in terms of dollars with the cost of medicaid compared to last year? guest: with $596 billion last year, so about 15% of that, 10% would be about 59 million. host: how does that compare to pre-expansion? guest: the growth has been about eight -- a 10% increase. medicaid has been growing all along. the primary areas of growth are the people with disabilities and those who are elderly, those are the largest components of growth. host: and in this segment of the washington journal, special

phone lines. those for medicaid recipients, your experiences in the program, especially if you have been covered under the expansion, call 202-748-8000. all others, 202-748-8001. we are coming off of the 2018 elections, medicaid expansion was on the ballot in some states. idaho, utah and nebraska approved ballot measures to expand medicaid. what is the process from here? guest: many of the things under the affordable care act had to do regardless of its decision to expand medicaid, so they had to do a new eligibility determination that was basically textbased. -- tax based. and they also had to coordinate with exchanges where people could purchase federal insurance, subsidized or -- i'm sorry, purchase private insurance subsidized or on their

own. so for those who decided to expand, two things -- one, make sure they have systems that follow the rules under the affordable care act for the expansion population. and secondly, there is a different amount of federal contributions. so they also have to make sure they are getting the right amount of money for those individuals. host: what would the cost sharing deal that the states that chose to expand took when they made the expansion? guest: initially, it was 100% federal funding for any state to that decided to expand for that particular population. over time it will go down to 90%. so it is a higher matching rate. generally the states' matching rates are 50%-70%. host: that payment by the federal government is for those estates that are newly expanding their medicaid programs, do they

get that right now? they are coming in midway through? guest: midway through, so closer to 90%. host: when will it hit 90%? guest: 2020. host: what are some different ways states have thought to cover their share of the payment? guest: most of it has been through really, state revenues. itut three fourths of states comes from state sources like taxes, sales tax, those types of things. 25% comes from other areas. and there are two broad categories. one is health care providers, they may tax a hospital or others to work with revenue for the state share. and the other is local governments. the city governments also contribute. host: what state has a unique program for covering this? guest: they are all unique. [laughter] the variety across the states

and the way that they finance and operate medicaid is really amazing. some states are at 100% managed care, others do combinations of everything you can think of. host: explain managed-care. guest: that is where you essentially are contacting with an organization to provide all of the services for a set payment. and generally, it can be a per member, per month, but it has been a way for states to manage the cost and have more predictability of cost. host: the kaiser family foundation, this shows the status of state medicaid expansion adopted in 37 states, including washington dc. you can see on the map those with the blue and gray stripes, those are the ones we are talking about with the ballot measures to expand their medicaid programs. oranges states, those who have not adopted medicaid expansion. we are talking about the

program. we want to hear your experiences in the program, especially if you are one of those who started receiving coverage under the affordable care act. 202-748-8000 is the number for medicaid recipients. 202-748-8001 for all others. we are talking with carolyn yocom from the government accountability office. how long have you been covering issues there? guest: since 1990. host: how much of your focus is the medicaid program particularly? guest: close to 100%. i also look at the children's health insurance program. host: charlotte is up first, a medicaid recipient in st. louis, missouri. caller: good morning. i wonder if you could tell me why -- what the difference is or the concern that people have with managed-care versus

the concern people have with managed-care, because i hear so many bad things about it and i am unsure if it is a good or bad thing. and also, the difference between spend down, or explain what that is, too. i have that through medicaid on my medicaid coverage, and i do not really understand how they calculate that. thank you. host: thank you for the question. guest: first of all, managed care can be a great way to provide services in the medicaid program. the things that we have raised about managed care have been a lack of information. we do not always know how the money is a spent or where it goes. and we do not believe that the risks are being accounted for. and in managed-care you can have a risk of the money going out the door, but the service is not being provided.

and we would like more assurance that the money is going out the door into services are being provided to those who need it. host: what are some of the big providers people may have heard of? guest: united health care, and mary group, -- amerigroup. host: how many are there total? guest: a fair number that are participating in managed care, i could not give you an exact number. host: are those that you mentioned, do they make up the majority or are there a couple big players? guest: more than a couple big players. and they can be regionally based. there are programs that operate in particular parts of the united states. to get to charlotte's question about spend down, spend down is what happens when you are not in an expansion population, you are in a different category of medicaid that has a was been covered. and what happens, if you have to

spend it down your income and resources in order to meet the income and resource qualifications for medicaid. it cannot get -- i cannot get specific, because each state has different levels in which they provide coverage, but essentially what they are doing is tracking that your income and resources are low enough that you qualify for medicaid. host: another medicaid recipient, greg in texas. good morning. caller: good morning. guest: good morning. caller: i'm glad to have this talk. this was the most embarrassing thing for me to get medicaid, because i thought it was mainly for people who did not want to work and were lazy. and when i had my insurance, i had of the worst insurance that i could get paying insurance. and when i got on medicaid, i got the best help from the best doctors. they would fight to get the approval from the insurance

companies, but medicaid takes care of me better than i have ever been taken care of. and i am embarrassed to get it. another question, i do not have anything against people coming over here, but there are so many people coming over having babies, in my neighborhood they are having babies every six months and it puts a burden and they have hoodlums working. and they usually get identification to claim these benefits and parents people who really do need medicaid. and all of the stimulus check, they are getting hundreds of dollars every month for kids. and they are blowing it, buying cars and all this other stuff, in the black community too. we have to cut down on that. medicaid is the best thing that ever happened to me. host: do you want to talk through a couple of the issues he brought up? guest: i am really glad to hear

medicaid has done its job for you. that is always the best news. with regard to people who are noncitizens, medicaid does have a citizenship check. notso an individual who is a citizen of the united states only gets really emergency care at most, and sometimes not that, depending on the different circumstances. so it is -- i understand the concern you are raising, but for the most part citizenship is one of the base requirements. host: the color said originally he was embarrassed -- caller said he was originally embarrassed to get on it. can you talk about work requirements. how states have implemented those and the status of that? guest: i can tell you what we will be working at. we will be working at what kind of approvals are there for

beneficiary and work requirements. we are also going to look at the administrative costs associated with implementing that. does it take extra money to implement work requirements? and how those centers for medicaid and medicare review work requirements and make approvals. host: for viewers of the program, you may know what the government accountability office is, but for somebody who has not heard about it explain what you do there and your role when it comes to oversight. guest: we have a special role in the federal government. we are in investigative arm of congress and we work for both parties. we pride ourselves on our work being nonpartisan and fact-based. so our focus is to provide convert -- congress and the american public with the facts they need to better understand the program. host: joe is a medicaid recipient in new york city. good morning. caller: good morning.

thank you for c-span. i want to echo what you heard from the gentleman in texas. host: what is that? caller: my spirits with medicaid -- i am close to medicare age, but i have had insurance from fortune 100 companies, from start up companies, over a different kinds of health insurance in my lifetime , and i have to say the obama medicare expansion really saved my life. and it is the best insurance i have ever had. [sigh] guest: thank you, it is gratifying to hear the program is working for those who need it. one of the big areas of uninsured individuals in the united states prior to the affordable care act really was people in their 50's, potentially employed, potentially not, but without access to employer-sponsored insurance.

host: you talked about your concern with the transparency of managed care programs. where else has gao expressed concerns, what is not working? guest: we have expressed another area of concern, probably two broad areas. one improper payments, making sure payments are going to the right place. level,ee for service those improper payments are at 12%. so when you're not in managed care, they are paying on a bill by bill basis. so that money has been 12% error rate, that is what we have identified and reported. host: how does that compare historically? guest: that has been growing. we have some work coming out that is looking at those improper payment rates and what is going on there. a second area, medicaid offers

flexibility through demonstrations, where you can expand the program and waive particular parts of the program to provide services differently. thi can be -- this can be a really good thing, because health care has changed over the past 50 years. the downside is states have used some of the mechanisms here to shift cost over to the federal government. and this is a partnership program. we think people need to come to the table with some better sharing of the dollars. is thegain, gao.gov place to go for these reports. carlos in fort lauderdale, florida, a medicaid recipient. good morning. caller: good morning. i want to congratulate carolyn yocom in the program and for

being for us and talking about this subject. i just turned 65 and i am concerned about the future of medicare. and we are covered under the medicare. and i - i am concerned about the our medicare how .enefits will be affected they might cut, the government might cut the funding for that. and i would like to recommend that i think we -- or the government needs to separate the cost of medicare and since medicare recipients pay into medicaid, i think that that should be separated so they know -- so they try not to affect us. and if you divide it into other

groups, who is receiving medicaid, the government can actually go to try to control the cost or reduce the cost. so that is my recommendation. thank you. host: thank you. guest: medicare is financed and pay for separately. so in some ways the money is already segregated, carlos. medicaid comes from state revenues and from federal expenditures. medicare operates pretty much via trust funds that are set up and established especially for those programs. um, there are people who qualify for both and they are called dual eligible people, the qualify for medicare and medicaid. under those circumstances, medicaid pays cost-sharing for the medicare programs. and medicare does what it always does. host: and from new carlisle,

ohio, good morning. caller: good morning. guest: good morning. caller: i was wondering how many illegals are on medicaid. and how much is this costing the american taxpayer? guest: as i noted before, anna, citizenship is a requirement for the program. you have to show proof of citizenship. and also a social security number in order to be eligible. host: is that for the children as well? guest: yes. host: ralph, charlottesville, virginia. good morning. caller: i have a question for miss yocom. the medicare program, i think there is a lot of abuse and fraud in the program. i will tell you why. in virginia, i know several toes, i have talked community members and know several cases of individuals who are not disabled and have two or

three children and are on medicaid and working. and now i know of a situation where an individual just got a job after two or three years in virginia, the two children are on medicaid and the individuals are cared for by the mother. and the mom is under a government program, whereby she is receiving medicaid for the children, and it is illegal. there is a lot of illegal stuff going on and i think it has to be corrected. i want to know the percentage, you mentioned the percentage of people on medicaid, the majority was elderly and disabled. but it is hard to believe that is a majority, because children make up a large amount of that cost in medicaid. and um, i think that those percentages are, that you have given, i cannot see that as well as a lot of community members cannot see that. and i am not saying people do not qualify for medicaid, but

that has to be looked at totally -- who qualifies in who can get medicaid. and a lot of people who are not disabled -- i have no problem with that, i do not have a problem with the elderly, but we need to pull out the fraud and abuse and there is a lot of that going on in every state in the union. host: maybe these numbers will help before carolyn yocom expands on them. this from the gao. medicaid enrollment, 36 million children. about 13.7 million from the expansion. due to medicaid expansion under the aca. 10.2 million other adults, a point really am blind and disabled americans. 5.4 million elderly. guest: thank you. and overall, children are less than 20% of the cost, but almost 50% of the population in the program.

children can be inexpensive to care for. they need immunizations, regular checkups, but it is always not expensive. you are correct to be concerned about eligibility. one of the unfortunate things that has happened since the affordable care act was passed, is there have not been public, open reviews of eligibility determination. estimated, an improper rate due to people not eligible for the program, they froze a rate of 3% and have not been reporting it. gao has been very concerned about that. this is the first year where cms is once again going to be testing and measuring eligibility, so it has been four years since we've had a number that is actually real. host: about 10 minutes left in this segment. again, special phone lines.

if you are a medicaid recipient, 202-748-8000. we want to hear your questions, your experience with the program. all others, 202-748-8001. pat is a medicaid recipient in willis, texas. caller: good morning. i am not a recipient. i happen to be calling in. i had -- i guess my question is, what is the eligibility to get on medicaid? i know of a friend who came down with cancer and he didn't have personal insurance, but he was above the level to get on it. and he eventually died without any treatment at all. so i am curious what are the entry levels that people need to be about to get this type of coverage. guest: yeah, it is complicated. medicaid has different eligibility levels depending on

the categoryof -- of population we are talking about. for children generally, the relationship is to the federal poverty level. and it is 133% of the federal poverty level. 200%me cases, states go at or 300% for children. host: so the state can set that level? guest: they can. with the expansion, that went to the 133%. and then for other adults in the program, it depended on the retion on what the poverty level would be for adults. in some cases, it can be as low as 9% of the poverty level before people are eligible. in other states, it has been higher. the other way that people can get on medicaid, this goes back to the question about spend down

that was earlier in the program. people can spend it down their income and resources and qualify for medicaid, but the unfortunate truth is if you have something like cancer and spending it down takes a while, you could be difficult -- it could be difficult to get that care as soon as would be best. host: what are the requirements in the category of those who are disabled? guest: it will also vary by state. and there is also a need to be determined disabled. host: what does that mean? guest: caller: some states -- states do it through the social security programs, other states do it themselves. so the assessments that are done can also vary. host: carolyn yocom with us from the gao for a few more minutes, taking your calls and questions. we have a line for medicaid

recipients. our caller from oregon, good morning. caller: what is the problem with medicaid and medicare covering alternative medicines? on medicaid, we had to sign a waiver promising to pay for our visit, just in case there was no money available to cover. and in medicare, it only covers chiropractors, not acupuncture. guest: i do not know much about this area. i do know that states can have discussion on what gets covered. there is a benefit package for medicaid and a there can be approvals to expand that benefit package to things like alternative medicines. but it would really be a discussion between the state and the centers for medicare and medicaid services. host: sandra in springdale, pennsylvania.

good morning. caller: good morning. guest: good morning. caller: i am on medicaid and i am 62 years old, disabled. i have been for 30 years. i am on social security disability, which i worked for. in food i get $41 stamps in a month. i have an acquaintance that has children that gets $800 plus hud. how does this make sense? guest: i can tell you about the medicaid component, but i am not familiar with the other program. host: do you want to talk through the medicaid program a little bit? inst: yes, medicaid has -- some ways when someone has worked and is eligible for ssci, medicaid operates a little bit like it does with medicare and people eligible for both programs in that it can help pay premiums and copayments, and

provide additional support. host: bill on that line for medicaid recipients from gary, indiana. caller: good morning. i'm 69, low income, and i am on both medicare and medicaid. even though indian is a split state, we are sometimes democrat, mostly republican. we now have two republican senators and a republican governor, and the state legislature has a super majority of republicans. but medicare should not be a political issue. in my opinion, medicare and medicaid saved my life. so i will be a booster of the program and i believe everybody in the u.s. who is qualified should receive it. there is probably fraud in everything. i do not know how you can kneel down a specific. you have different cases. i know they investigate in indiana quite thoroughly. they will even come to your

home. in terms of fraud, i think it is like a bullet point thing than in emotional issue, because these two programs are doing a fantastic job. and i got as old as i did because of them, because i would've died of heart problems. i would not have been able to pay for them, even though i did have private insurance most of my life. when i became disabled, marr world it changed. i -- my world it changed. i wish people would walk in others' shoes for a while so see life and how it is. i was medically fit 100%, everything was to me like people are taking advantage of the system. i would have bad thoughts like that. but once i found out exactly what we are needing in this country, because i am a baby boomer and we are old. we are getting older. we are elderly and we are getting different diseases, some sections of the population are living longer, but we still have

to tackle alzheimer's, that is a big issue, especially for women. those are my comments. host: thank you for sharing your story. carolyn yocom, before we get close to the end of the program, we talked about bounce initiatives earlier and the state looking to expand medicaid. montana had a ballot initiative that would've looked to continue funding for their medicaid expansion passed june of next year, but the initiative failed. so what happens from here and what happens to the people currently in montana's medicaid expansion? guest: it is going to be up to montana. i cannot speak to their particular circumstances, but states from time to time have run into situations where they are concerned about the ability to finance medicaid. there are choices that can always be made -- they can constrain costs, limit eligibility, change benefit packages to make that work.

so, and states over the course of the program have done all three of those. host: in terms of making medicaid work r the long-term, what are the current projections right now for the fiscal health of the program? guest: it is projected to hit $1 trillion i think in about 10 more years, if i remember correctly. so it is growing very quickly. and it -- host: how concerned is the gao? guest: we are concerned about the growth and affordability of the program, yes. and wanted to make sure that every dollar spent is really going -- we have heard it stories of people who need the program and rely on it, but our job is to make sure every dollar spent goes to the right place. host: one more call from betty in pennsylvania, go ahead. caller: hi, this is betty. good morning to both of you. on military, are they not

medicaid because it is a government program? there can be service members who are on medicaid. medicaid is what they call a payer of the last resort, so if you have anything else first it pays, the medicaid covers the rest. so for the most part, service members to have coverage through va, but medicaid can be a piece of that. host: carolyn yocom is the health care studies director at the government accountability office. gao.gov. ♪ c-span's washington journal. live every day with news and policy issues that impact you. coming up tuesday morning, current club for growth president, david mcintosh, on what he thinks the republicans lost the house. and washington post opinion

letter greg sargent, joins us to discuss his book, on the civil war. and come my discussion on the upcoming lame-duck professional session and this week's gop leadership elections. be sure to watch live a 11:00 a.m. eastern tuesday morning. joined the discussion. >> here is some of our live coverage tuesday. the confirmation hearing for five of president trump's judicial nominees including third circuit court of appeals nominee, paul nati, who is opposed by his home state coryors, bob menendez and booker. members this week consider a bill to remove the gray wolf from the endangered issues list. and come out members elected to fill seats to the rest of the year will before and and.

in.ill be sworn later the senate returns to continue debate on renewing coast guard funding programs. , ae on c-span three discussion on advances in cancer detection and treatment at 8:30 a.m., and the senate judiciary committee holds a hearing on bank bankruptcy at 2 p.m. next, the supreme court oral arguments in the case deciding whether the federal government can applies sex offender registration requirements on those convicted wiretap 2006, when the lowest enacted. the men who brought the case was convicted of a sexual offense in 2005. this is a little less than