The Trump administration's efforts to impose work requirements on Medicaid cost more than $400 million in paperwork and other wasteful administrative spending in a handful of states, a government watchdog said in a report released on Thursday.

The General Accountability Office, a nonpartisan agency serving Congress, identified a hole in the states' approach.

It said the Centers for Medicare and Medicaid Services had allowed states to set work requirements without mandating projections on how much it would cost administratively.

The price tag ranged from $6.1 million in New Hampshire to $271.6 million in Kentucky, totaling around $407 million.

The report will likely heighten scrutiny on the Trump administration's efforts to implement work requirements for Medicaid, the federal program that's provided free health insurance to low-income and disabled Americans for over five decades.

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The Trump administration's efforts to impose work requirements on Medicaid cost more than $400 million in paperwork and other wasteful administrative spending in a handful of states, a government watchdog said in a report released on Thursday.

The General Accountability Office — a nonpartisan agency serving Congress — identified a hole in the states' approach. It said the Centers for Medicare and Medicaid Services had allowed states to set work requirements without mandating projections on how much it would cost administratively.

The report also noted that wasn't consistent with federal standards and the watchdog faulted CMS for endangering its "transparency."

Read more: A new study showed one of the Trump administration's biggest healthcare changes failed at its main goal

"Without requiring states to submit projections of administrative costs in their demonstration applications, and by not considering the implications of these costs for federal spending, CMS puts its goals of transparency and budget neutrality at risk," the GAO said in its report.

The costs of implementing Medicaid work requirements ranged from $6 million in New Hampshire to $271 million in Kentucky. Government Accountability Office

The GAO report investigated how work requirements were implemented in New Hampshire, Arkansas, Indiana, Wisconsin, and Kentucky. The price tag ranged from $6.1 million in New Hampshire to $271.6 million in Kentucky, totaling around $407 million in five states.

Democrats seized upon the report to criticize the work-requirements, which the Trump administration argued would help lift people people out of poverty and push them to rely on themselves. Sen. Ron Wyden and Rep. Frank Pallone — who requested the study last year — blasted the work requirements and called them "a boondoggle" in a press release.

"This report is yet another sign that Medicaid work requirements have been a boondoggle from the start and should be ended immediately," Wyden and Pallone said.

Read more: The Trump administration just opened the door to an enormous change to Medicaid

A CMS spokesperson swung back at the GAO report in a statement to Business Insider, saying its examination was only drawn from "a handful of states" and it failed to take state data into account.

"The GAO's conclusions are drawn from only a limited review of a handful of states, and they failed to assess the self-reported state data against the actual federal certification requirements that would ultimately determine which costs would qualify for federal funding," a spokesperson said. "[W]e will continue to work diligently to protect federal taxpayers against any impermissible spending."

But healthcare policy experts noted funds were being redirected from insurance coverage to government bureaucracy.

"The GAO report confirms that restrictive waivers are diverting millions of dollars from coverage to bureaucracy – without changing the reality that these policies don't work," Judith Solomon, a senior fellow and Medicaid expert at the Center on Budget and Policy Priorities, told Business Insider in an email.

Solomon added that public money was needlessly being spent on informing people affected by the work mandate, when it could have gone to insuring them instead.

"For example, New Hampshire spent $187,000 on outreach including door-to-door but reached fewer than a thousand people," she said, referring to the state's effort to educate people about the change. "Similarly, the report shows managed care plans in Kentucky hired 270 workers to process exemptions. These are all funds that could go for coverage."

Big-picture implications

The report will likely heighten scrutiny on the Trump administration's efforts to implement work requirements for Medicaid, the federal program that's provided free health insurance to low-income and disabled Americans for over five decades.

Four of the five states examined have confronted lawsuits over the Medicaid job mandate. Kentucky and Arkansas had their work requirements thrown into federal court and a panel is scheduled to hear oral arguments in the lawsuit on Friday.

CMS has so far approved requests from nine states to impose job requirements and it has nine others pending.

Public health advocates have criticized the work requirements saying it would lead to large coverage losses. Its rollout in Arkansas was particularly messy as thousands of working-age adults lost their health insurance coverage and a spike in the uninsured followed, according to a study published in June. And at least 18,000 enrollees were kicked off the program before a federal judge blocked the rule earlier this year, the Washington Post reported.

In Medicaid, benefits are generally available to anybody who meets a set of criteria laid out by the state and federal government. And the program's steady expansion under the Affordable Care Act has swelled its coverage to 75 million people — or around one in five Americans. That's up from 50 million people in 2010, shortly after the ACA was passed.