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MACPAC Meets

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 Looks at Medicaid DSH

Hospitals that serve especially large numbers of Medicaid and low-income patients still need Medicaid disproportionate share hospital payments (Medicaid DSH) to avoid red ink despite the expansion of Medicaid and the increase in the number of uninsured people fostered by the Affordable Care Act.

So concludes the Medicaid and CHIP Payment and Access Commission (MACPAC) the non-partisan legislative branch agency that advises Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on Medicaid and Children’s Health Insurance Program issues.

In its March 2017 report to Congress, MACPAC writes that

In both expansion and non-expansion states, deemed DSH hospitals, which are statutorily required to receive DSH payments because they serve a high share of Medicaid-enrolled and low-income patients, continue to report negative operating margins before DSH payments. Read more

MACPAC Meets, Discusses Medicaid, CHIP Issues

The non-partisan legislative branch agency that advises Congress, the Secretary of Health and Human Services, and the states on a variety of Medicaid and State Children’s Health Insurance Program issues met last week in Washington, D.C.

Among the issues on the agenda of the Medicaid and CHIP Payment and Access Commission were:

  • the flexibility of states in structuring and administering their Medicaid and CHIP programs
  • state Medicaid responses to fiscal pressures
  • studies requested by Congress on mandatory/optional benefits and populations
  • current Medicaid parallels to per capita financing options
  • illustrations of state-level effects of per capita cap design elements
  • high-cost hepatitis C drugs in Medicaid
  • the role of section 1915(b) waivers in Medicaid managed care

Because they serve so many Medicaid and CHIP patients, private safety-net hospitals are especially interested in what MACPAC has to say about these and other subjects.

Go here, to the MACPAC web site, for links to documents on all of these subjects.

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 Meets, Discusses Medicaid DSH Issues

Last week the Medicaid and CHIP Payment and Access Commission met in Washington, D.C. to review aspects of its required March report to Congress and to address other Medicaid and CHIP issues.

Included on the agenda of the meeting were:

  • a review of chapters of the March report on Medicaid disproportionate share (Medicaid DSH) and monitoring of access to care;
  • alternative approaches to state financing of their Medicaid programs;
  • Medicaid coverage for low-income adults; and
  • Medicaid program integrity issues.

MACPAC’s efforts, although not binding on the administration, carry a great deal of weight with those institutions.  In addition, they are very important to urban safety-net hospitals because those hospitals care for so many Medicaid patients.

See the presentations used to help guide these discussions here, on MACPAC’s web site.

MACPAC Looks at Medicaid DSH

With Medicaid disproportionate share payments (Medicaid DSH) facing future reductions, the agency charged with advising Congress on Medicaid and Children’s Health Insurance payment and access matters is considering what changes the federal supplemental Medicaid payment program might need.

macpacAt a recent meeting in Washington, D.C., the Medicaid and CHIP Payment and Access Commission discussed the changing role and purpose of Medicaid DSH as more Americans obtain health insurance through private or public sources. MACPAC commissioners noted that hospital uncompensated care is falling, especially in states that have taken advantage of the Affordable Care Act to expand their Medicaid programs.

A new Medicaid DSH formula set to be used for FY 2018, based more heavily than the current formula on the number of uninsured people in individual states, is expected to result in larger-than-average reductions for hospitals in Medicaid expansion states.

Among the steps commissioners discussed were examining how hospitals use their Medicaid DSH funds; considering how any changes in the distribution of Medicaid DSH funds might affect other parts of states’ health care systems; and the role states should play in determining the allocation of Medicaid DSH funds.

Medicaid DSH funds are a vital source of support to help private safety-net hospitals care for their many uninsured patients.

For a closer look at the issue and MACPAC’s deliberations, see this CQ Roll Call article presented by the Commonwealth Fund.

MACPAC Meets

The federal agency responsible for advising Congress on Medicaid and Children’s Health Insurance Program payment and access issues met last week in Washington, D.C.

According to the Medicaid and CHIP Payment and Access Commission,

The initial sessions of MACPAC’s September 2016 Commission meeting focused on hospital payment policy, first discussing MACPAC’s new work to develop an index of Medicaid inpatient payments across states and relative to Medicare, and later looking at how Affordable Care Act coverage expansions have affected hospitals serving a disproportionate share of low-income patients, including those with Medicaid coverage. The Commission then reviewed state policies for covering and paying for services in residential care settings, part of the drive to rebalance long-term services and supports from institutions to the community.

A briefing on MACPAC’s recent roundtable on improving service delivery to Medicaid beneficiaries with serious mental illness kicked off the afternoon sessions, followed by a discussion of Medicaid financing and its relationship to provider payment policies. At the final session of the day, the Commission reviewed the possible elements of a package of recommendations on children’s coverage and the future of CHIP.

The following are the presentation materials referenced during the meeting:

MACPAC’s deliberations often have implications for private safety-net hospitals.

 

 

MACPAC Unhappy With How DSH is Dished

Medicaid disproportionate share hospital payments (Medicaid DSH) are not getting to the hospitals that need them most, according to the independent agency that advises Congress and the administration on Medicaid access, payment, and care delivery issues.

In its March 2016 Report to Congress on Medicaid and CHIP, the Medicaid and CHIP Payment and Access Commission found

…little meaningful relationship between DSH allotments and three aspects of DSH payments that Congress asked us to study: 1) the relationship of state DSH allotments to data relating to changes in the number of uninsured individuals, 2) data relating to the amount and sources of hospitals’ uncompensated care costs, and 3) data identifying hospitals with high levels of uncompensated care that also provide access to essential community services for low-income, uninsured, and vulnerable populations.

macpacMACPAC also observed that

Although early reports suggest that the coverage expansions are improving hospital finances in general, it is not yet clear how hospitals that are particularly reliant on Medicaid DSH payments are being affected.

MACPAC further maintains that

…DSH allotments and payments should be better targeted, consistent with their original statutory intent.

Noting an obstacle to such an undertaking, MACPAC

…recommends that the Secretary [of Health and Human Services] collect and report hospital-specific data on all types of Medicaid payments for all hospitals that receive them. In addition, the Secretary should collect and report data on the sources of non-federal share necessary to determine net Medicaid payment at the provider level.

Finally, MACPAC promises to continue looking into this challenge and exploring possible solutions.

In future reports on DSH payment policy, which MACPAC will include in its annual March reports to Congress, the Commission will continue to monitor the ACA’s effect on hospitals receiving DSH payments. We also plan to explore potential approaches to improving targeting of federal Medicaid DSH funding, including modifying the criteria for DSH payment eligibility, redefining uncompensated care for Medicaid DSH purposes, and rebasing states DSH allotments.

To learn more about what MACPAC had to say about Medicaid DSH and other Medicaid- and CHIP-related issues, go here to see the MACPAC report March 2016 Report to Congress on Medicaid and CHIP.