In recent testimony before the Committee on Oversight and Government Reform of the House of Representatives, the Government Accounting Office ("GAO") Managing Director reported on CMS' lack of clarity regarding inappropriate Medicaid state financing arrangements. The GAO found problematic cases in which claims for federal matching funds appeared inconsistent with federal law. GAO concluded and testified that Medicaid supplemental payments have resulted in billions of excess federal dollars for states, yet that CMS accountability for these payments is lacking. GAO called for greater transparency of CMS oversight, and further, that clarification be provided to the states regarding appropriate financing arrangements. This testimony is indicative of the pressure CMS is confronting regarding state Medicaid financing arrangements in Washington and provides additional insight into its recent actions to audit and defer Medicaid payments to various states.