The Medicaid and CHIP Payment and Access Commission met last week in Washington, D.C. to discuss a variety of Medicaid and Children’s Health Insurance Program issues.

MACPAC, the non-partisan legislative branch agency that performs policy and data analysis and makes recommendations to Congress, the administration, and the states, addressed a number of issues during the meeting.  Among them it discussed Medicaid managed long-term services and supports (MLTSS) and voted to recommend that states be given the opportunity to seek permission to make Medicaid beneficiary enrollment in managed care plans mandatory through revisions of their state plan amendment rather than by seeking Medicaid waivers.

The commission also heard presentations on and discussed:

  • the integration of substance use disorder treatment with other Medicaid-covered services
  • residential substance abuse treatment and the exclusion of institutions for mental disease from treatment options
  • stakeholder experiences with MLTSS
  • Medicaid hospital payments
  • Medicaid managed care
  • the “Money Follows the Person” demonstration program
  • appeals for the dually eligible

MACPAC’s deliberations are important to private safety-net hospitals because those hospitals serve so many Medicaid patients.  While MACPAC’s recommendations are binding on neither the administration nor Congress, it is a respected source of insight and ideas and its recommendations often find their way into future regulations, legislation, and policy.

Go here for a summary of the meeting and links to the presentations used for these subjects.


The non-partisan legislative branch agency that advises Congress, the administration, and the states on Medicaid and CHIP-related issues met recently in Washington, D.C.

The following is the Medicaid and CHIP Payment and Access Commission’s own summary of its meeting.

The December 2017 meeting of the Medicaid and CHIP Payment and Access Commission began with a brief update on the State Children’s Health Insurance Program (CHIP). Although federal funding for the CHIP expired at the end of September, legislation to renew funding was still pending in Congress. The Commission then heard from a panel discussing state tools to manage drug utilization and spending in Medicaid. Panelists included Renee Williams, director of clinical pharmacy services for TennCare; Doug Brown, Magellan Rx Management’s vice president for Medicaid drug rebate management; and John Coster, director of the Center for Medicaid and CHIP Services Division of Pharmacy at the Centers for Medicare & Medicaid Services. At the final morning session, Commissioners reviewed a draft March 2018 report chapter on streamlining Medicaid managed care authorities. The Commission voted to approve recommendations to Congress, but deferred action on a third recommendation for further discussion at its upcoming January 2018 meeting.

In the afternoon, MACPAC staff previewed highlights from the December 2017 MACStats: Medicaid and CHIP Data Book. MACStats pulls together Medicaid and CHIP data from multiple sources that often can be difficult to find. The collection is published annually and individual tables are updated throughout the year. The Commission then reviewed the draft March report chapter on telemedicine in Medicaid, and later in the day the Commission returned to the topic of prescription drugs, to explore potential recommendations on the Medicaid drug rebate program.

The final December sessions covered MACPAC’s annual analysis of disproportionate share hospital payments (a required element of its March reports), and findings from interviews with four states to better understand how they are implementing Section 1115 Medicaid-expansion waivers.

The following presentations, many with supporting documents, were offered during the MACPAC meeting:

  1. State Strategies for Managing Prescription Drug Spending
  2. Review of March Report Chapter: Streamlining Managed Care Authorities
  3. Highlights from MACStats
  4. Review of March Report Chapter: Telemedicine in Medicaid
  5. Potential Recommendations on Medicaid Outpatient Drug Rebates
  6. Review of Draft March Report Chapter: Analyzing Disproportionate Share Hospital Allotments to States
  7. Implementation of Section 1115 Medicaid Expansion Waivers: Findings from Structured Interviews in Four States


The Medicaid and CHIP Payment and Access Commission met recently in Washington, D.C.

Among the issues MACPAC commissioners discussed during their two-day meeting were:

  • delivery system reform incentive payment programs
  • Medicaid enrollment and renewal processes
  • managed care oversight
  • monitoring and evaluating section 11115 demonstration waivers
  • Medicaid coverage of telemedicine services

MACPAC advises the administration, Congress, and the states on Medicaid and CHIP issues.  It is a non-partisan agency of the legislative branch of government.

Go here to find background information on these and other subjects as well as links to the presentations that MACPAC staff made to the commissioners during the meetings.


Last week the Medicaid and CHIP Payment and Access Commission met in Washington, D.C.  The agency performs policy and data analysis and offers recommendations to Congress, the Department of Health and Human Services, and the states.

During two days of meetings, MACPAC commissioners received the following presentations:

  • Federal CHIP Funding Update: When Will States Exhaust Their Allotments?
  • Review of June Report Chapter: Program Integrity in Medicaid Managed Care
  • Review of June Report Chapter: Medicaid and the Opioid Epidemic
  • Medicare Savings Program: Eligible But Not Enrolled
  • Medicaid Reform: Implications of Proposed Legislation
  • Preliminary Findings From Evaluations of Medicaid Expansions Under Section 1115 Waivers
  • Potential Effects of Medicaid Financing Reforms on Other Health and Social Programs
  • Review of June Report Chapter: Analysis of Mandatory and Optional Populations and Benefits
  • Managed Long-Term Services and Supports: Network Adequacy for Home and Community-Based Services
  • Update on MACPAC Work on Value-Based Payment and Delivery System Reform

For links to all of these publications and a transcript of the two-day meeting go here, to the MACPAC web site.

New MACPAC Reports

The Medicaid and CHIP Payment and Access Commission has released several new reports, including:

  • a look at how states exercise flexibility in their individual Medicaid programs;
  • methodologies for setting Medicaid per capita caps;
  • a review of how states are addressing high-cost hepatitis C drugs in their Medicaid programs;
  • an analysis of Medicaid disproportionate share hospital payment (Medicaid DSH) allotments and payments; and
  • an analysis of when states will exhaust their CHIP allotments.

MACPAC is a non-partisan legislative branch agency that advises Congress, the states, and the administration on Medicaid and CHIP payment and access issues.

Find links to these and other MACPAC reports here, on the MACPAC web site.

New MACPAC Study Evaluates Medicaid, Medicare Payments

Medicaid payments to hospitals are comparable to or even higher than Medicare payments.

Or at least they are once supplemental Medicaid payments are included.

So concludes a new study by the Medicaid and CHIP Payment and Access Commission, a non-partisan legislative branch agency that advises the states, Congress, and the administration on Medicaid and CHIP payment and access issues.

In what MACPAC bills as the “first-ever study to construct a state-level payment index to compare fee-for-service inpatient hospital payments across states and to benchmark Medicaid payments to other payers such as Medicare,” the study found that

  • Across states, base Medicaid payment for inpatient services varies considerably, ranging from 49 percent to 169 percent of the national average. This variation is similar to the variation across states previously reported for physician fees.
  • States are not consistently high or low payers across all inpatient services due to differences in their payment policies.
  • Payment amounts for the same service can also vary within a state.

The MACPAC analysis also concluded that

  • Overall, Medicaid payment is comparable or higher than Medicare.
  • Specifically, the average Medicaid payment for 18 selected conditions was 6 percent higher than Medicare, and the average Medicaid payment for all but two of the conditions was higher than Medicare.
  • The average Medicaid payment for these 18 services was higher than Medicare in 25 states and lower than Medicare in 22 states.

Learn more about what MACPAC found in its new report “Medicaid Hospital Payment: A Comparison across States and to Medicare,” which can be found here, on MACPAC’s web site.

MACPAC Concerned About Prospect of Medicaid Block Grants

Members of the non-partisan legislative agency that advises Congress on Medicaid and CHIP issues expressed concern at their most recent meeting about the possibility of the federal government turning Medicaid into a block grant program.

At their meeting in Washington, D.C. last week, members of the Medicaid and CHIP Payment and Access Commission discussed the steps they would need to take to advise policy-makers about the issues they would need to address in making such a major policy change and the possibility that such a shift would result in a reduction of funding for Medicaid over time.

These issues are especially important to private safety-net hospitals because of the especially  large numbers of Medicaid patients they serve and the importance of Medicaid revenue to their overall financial health.

Learn more about the MACPAC discussion about Medicaid block grants in this Roll Call article.

MACPAC Points to March Medicaid DSH Report to Congress

Required to report annually to Congress on the state of the Medicaid program, members of the Medicaid and CHIP Payment and Access Commission reviewed drafts of their proposed March report to Congress at the agency’s January meeting in Washington, D.C.

In its draft report MACPAC addresses the Medicaid disproportionate share hospital payment program (Medicaid DSH), including DSH allotments, their relationship to the number of uninsured people, the amount and sources of hospital uncompensated care costs, and the impact of Medicaid DSH on hospitals that provide especially large amounts of uncompensated care while also providing essential community services.

The draft MACPAC report addresses:

  • the decline in the number of uninsured Americans;
  • the Medicaid DSH cuts scheduled to begin in federal FY 2018; and
  • the possibility of changing how Medicaid DSH payments are targeted to DSH-eligible hospitals.

All private safety-net hospitals receive Medicaid DSH payments and those payments are very important to them because they serve so many more uninsured patients than the typical community hospital.

See a draft of the chapter of the MACPAC report on Medicaid DSH here, on the MACPAC web site.

MACPAC Reports to Congress

The Medicaid and CHIP Payment and Access Commission (MACPAC) has released its second of two 2015 reports to Congress on Medicaid and the Children’s Health Insurance Program (CHIP).

In the report, the agency looks at the role of Medicaid in providing behavioral health services; examines Medicaid coverage of dental services for adults; contemplates the intersection between Medicaid and child welfare; and considers whether Delivery System Reform Incentive Payment (DSRIP) programs are a legitimate means of fostering health care delivery reform or have become just a means of states’ supplementing the Medicaid payments they make to providers.

Find a summary of the MACPAC report and a link to the complete report here.