Members of the Medicaid and CHIP Payment and Access Commission met publicly last week in Washington, D.C.

The following is MACPAC’s own summary of its meeting.

The March 2024 MACPAC meeting began with proposed recommendations on improving the transparency of Medicaid financing. The proposed recommendations are intended to improve the transparency of Medicaid financing methods, state-level financing amounts, and provider-level financing amounts. The presentation also included a recommendation to apply the proposed Medicaid financing transparency requirements to the State Children’s Health Insurance Program (CHIP). Staff reviewed the rationale for the recommendations and the implications for various stakeholders. The Commission will vote on the recommendation in April. 

Next, staff presented results from interviews with federal officials and policy experts on 1915(c) waivers that states use to operate home- and community-based services (HCBS) programs and policy options to address administrative requirements. The presentation began with an overview of Section 1915 authorities and the Centers for Medicare & Medicaid Services’ (CMS) notice of proposed rulemaking on ensuring access to Medicaid services. Staff also presented results from additional interviews with federal officials and policy experts that examined three specific areas: (1) lack of technical guidance for Section 1915(i) state plan amendments (SPAs); (2) the resource intensive renewal process for Section 1915(c) waivers and Section 1915(i) SPAs; and (3) the cost neutrality requirement for Section 1915(c) waivers. During this session, staff presented policy options to address these areas and solicited feedback from Commissioners.

Next, staff presented policy options based on findings presented in January 2024 regarding how states use their state Medicaid agency contracts with Medicare Advantage (MA) dual eligible special needs plans to integrate care for dually eligible beneficiaries, how these contracts are overseen, and the barriers that states face to leveraging these contracts. Staff described two policy options for the Commission’s consideration that would recommend that states collect data on care coordination and MA encounters and that CMS issue guidance supporting states in developing an integration strategy.

The Commission then heard a presentation on how Medicaid payment policies are used to support HCBS workers, including direct care workers, direct support professionals, and independent providers. Building off of findings from initial interviews with national experts that were discussed at MACPAC’s November 2023 public meeting, this presentation included additional findings from subsequent interviews with state officials and stakeholders in five states.

These interviews identified multiple strategies that states are pursuing to improve HCBS rate setting to ensure that rates are adequate to attract and retain enough HCBS workers to meet beneficiary care needs. The presentation also addressed challenges that states face in funding HCBS rates at recommended levels and ensuring that rate increases result in increased HCBS worker wages. The presentation concluded with a discussion of non-financial strategies that states are implementing alongside payment rate changes.

After a break, the Commission reviewed themes from an expert roundtable discussion on issues related to physician-administered drugs (PADs). Many of the high-cost specialty drugs in the pipeline, such as cell and gene therapies, require physician administration. As such, PADs are expected to be a key driver of Medicaid drug spending in the future. To help us examine issues related to PADs, MACPAC convened an expert roundtable with federal and state officials, drug payment experts, Medicaid managed care organizations, drug manufacturers, beneficiary advocates, and providers. MACPAC sought to better understand what strategies states are employing to manage spending on these treatments and determine if policy changes are necessary to help states develop different models for coverage, payment, or rebates that address these challenges. This session provided background information on how Medicaid policy differs for PADs compared to other drugs dispensed through a pharmacy, as well as themes emerging from the roundtable discussion, including potential strategies for states to address challenges in payment and utilization management.

Staff then shared findings from our federal and state policy scan on how states define children and youth with special health care needs (CYSHCN) and policies that guide care and coverage transitions. Medicaid plays a large role in covering health care services for CYSHCN. As these children reach adulthood, they need to transition from child to adult coverage and health care. Research indicates that these young beneficiaries and their families experience barriers during this transition. MACPAC found that there is significant variability in how states define CYSHCN and establish expectations for transitions.

On Friday, the Commission previewed a draft of the Medicare Savings Programs (MSPs) chapter for our June 2024 report to Congress. This chapter describes MSPs and their role in providing Medicaid assistance with Medicare premiums and cost sharing to individuals who are dually eligible for Medicaid and Medicare. It begins by providing an overview of the MSPs, and then discusses MACPAC’s prior work analyzing participation rates in the MSPs, including prior Commission recommendations aimed at improving participation in the MSPs. MACPAC contracted with the Urban Institute to analyze enrollment in each of the MSPs, using Medicare administrative data for calendar years 2010 through 2021. The draft chapter concludes with our new analysis of enrollment trends, including comparisons across MSPs. The analysis includes comparisons of enrollment trends by demographic characteristics including age, sex, and urban or rural residence.

The meeting concluded with a panel discussion on authorities and state Medicaid approaches for covering health-related social needs. Speakers described how they are providing services, such as housing and food support, through Medicaid authorities and flexibilities for covering these services. The discussion centered around the design considerations, implementation, and future trends when addressing Medicaid beneficiaries’ health-related social needs.

Supporting the discussion were the following presentations:

1. Proposed Recommendations for Improving the Transparency of Medicaid Financing
2. Medicaid Home- and Community-Based Services: Addressing Administrative Requirements
3. Optimizing State Medicaid Agency Contracts: Policy Options
4. Findings from Interviews about Medicaid Payment Policies to Support the Home- and Community-Based Services Workforce
5. Themes from Expert Roundtable on Physician-administered Drugs
6. Transitions of Coverage and Care for Children and Youth with Special Health Care Needs
7. Medicare Savings Program: Enrollment Trends

MACPAC is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide variety of issues affecting Medicaid and the State Children’s Health Insurance Program.  Because community safety-net hospitals and Alliance of Safety-Net Hospitals members care for so many Medicaid and CHIP participants, MACPAC’s deliberations are especially important to them.

Find MACPAC’s web site here.