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MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C.

The following is MACPAC’s own summary of the sessions.

MACPAC kicked off its January meeting with a review of a draft chapter for the March 2021 report to Congress and recommendations on a mandatory extension of Medicaid coverage for 12 months postpartum. The Commission received extensive public comment on the recommendations. On Friday, the Commission approved three recommendations as drafted related to postpartum coverage. The Commission recommended that Congress should:

  • extend the postpartum coverage period for individuals who were eligible and enrolled in Medicaid while pregnant to a full year of coverage, regardless of changes in income. Services provided to individuals during the extended postpartum coverage period will receive an enhanced 100 percent federal matching rate;
  • extend the postpartum coverage period for individuals who were eligible and enrolled in the State Children’s Health Insurance Program (CHIP) while pregnant (if the state provides such coverage) to a full year of coverage, regardless of changes in income; and
  • require states to provide full Medicaid benefits to individuals enrolled in all pregnancy-related pathways.

Commissioners then turned their attention to Medicaid estate recovery policies that affect beneficiaries using long-term services and supports (LTSS). Commissioners on Friday approved recommendations to:

  • make estate recovery optional rather than required;
  • allow states with managed long-term services and supports to pursue recovery based on the cost of services where it is less than the capitation payment paid to a managed care plan; and
  • direct the Secretary of the U.S. Department of Health and Human Services (HHS) to establish minimum hardship waiver standards, including a minimum estate value threshold for estate recovery.

Next, the Commission considered recommendations for countercyclical financing adjustments in Medicaid. This would allow federal financial stimulus to be directed to states more quickly during economic downturns and provide states with greater budget predictability. The Commission approved a recommendation that Congress should adopt a statutory mechanism to amend the Social Security Act to provide an automatic Medicaid countercyclical financing model, using the prototype developed by the U.S. Government Accountability Office as the basis. The Commission also recommended this policy change should include:

  • an eligibility maintenance of effort requirement for the period covered by an automatic countercyclical financing adjustment;
  • an upper bound of 100 percent on countercyclical adjusted matching rates; and
  • exclusion of countercyclical adjusted federal matching rate from services and populations that receive special matching rates (e.g., for the new adult group) or are otherwise capped or have allotments (e.g., disproportionate share hospital payments, territories).

After a break on Thursday, Commissioners discussed a draft chapter for the March 2021 report on design considerations for creating a new program for dually eligible beneficiaries and reviewed a report to Congress by the U.S. Secretary of Health and Human Services (HHS) on Medicaid housing supports for individuals with substance use disorder (SUD). The Commission plans to send a letter to HHS and leadership of relevant congressional committees commenting on the Secretary’s report to Congress on Medicaid housing supports for people with SUD who are experiencing or at risk of homelessness.

Next, Commissioners heard a panel discussion on the outlook for state budgets and the implications for Medicaid with Emily Blanford, program principal at the National Conference of State Legislatures; Shelby Kerns, executive director for the National Association of State Budget Officers; and Susie Perez Quinn, government affairs director for the National Governors Association. * The day ended with a presentation on value-based payment for maternity services.

On Friday, Commissioners heard a panel discussion on how Medicaid serves people with intellectual or developmental disabilities with Sharon Lewis, a principal at Health Management Associates; Melissa Stone, director of Arkansas’ Division of Developmental Disabilities Services; and Elizabeth Weintraub, a senior advocacy specialist at the Association of University Centers on Disabilities. * Additional sessions focused on a congressionally mandated MACPAC study of non-emergency medical transportation (NEMT), which will be included in the June 2021 report to Congress. In addition, Commissioners heard a new analyses of care integration for dually eligible beneficiaries, and a discussion of potential new models for payment and coverage of high-cost specialty drugs. The meeting concluded with a discussion of mental health parity in Medicaid.

Supporting the discussion were the following briefing papers:

  1. Postpartum Coverage: Review of Draft Chapter and Recommendation Decisions
  2. Medicaid Estate Recovery Draft Chapter and Recommendations
  3. Automatic Countercyclical Financing Adjustment Review of Draft Chapter and Recommendation Decision
  4. Establishing a Unified Program for Dually Eligible Beneficiaries Design Considerations
  5. Review of the Secretary’s Report on Medicaid Housing Supports for Individuals with Substance Use Disorder
  6. Value-Based Payment for Maternity Care in Medicaid
  7. Mandated Report on Non-Emergency Medical Transportation Further Findings
  8. Integration of Care for Dually Eligible Beneficiaries: New Analyses
  9. Payment and Coverage of High-Cost Specialty Drugs Report from Technical Advisory Panel
  10. Implementation of the Mental Health Parity and Addiction Equity Act in Medicaid and CHIP

Because they serve so many Medicaid and CHIP patients – more than the typical hospital – MACPAC’s deliberations are especially important to private safety-net hospitals.

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.  Find its web site here.

 

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C.

The following is MACPAC’s own summary of the sessions.

The October 2020 MACPAC meeting opened with a panel discussion on restarting Medicaid eligibility redeterminations when the public health emergency ends.  It included Jennifer Wagner, director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities; René Mollow, deputy director for health care benefits and eligibility at the California Department of Health Care Services; and Lee Guice, director of policy and operations at the Department for Medicaid Services, Kentucky Cabinet for Health and Family Services.

After a break, Commissioners heard a panel discussion with Kevin Prindiville, executive director at Justice in Aging; Mark Miller, executive vice president of healthcare at Arnold Ventures; and Charlene Frizzera, senior advisor at Leavitt Partners, on creating a new program for dually eligible beneficiaries. Later, staff presented preliminary findings from a mandated report on non-emergency medical transportation. The day concluded with a report on nursing facility acuity adjustment methods.

On Friday, the day began with a session on access to mental health services for adults in Medicaid. It was followed by a related panel discussion on mental health services with Sandra Wilkniss, director of complex care policy and senior fellow at Families USA; Melisa Byrd, senior deputy director for the District of Columbia Department of Health Care Finance; and Dorn Schuffman, director of the CCBHC Demonstration Project at the Missouri Department of Mental Health.

Next, the Commission considered the merits of extending Medicaid coverage for pregnant women beyond 60 days postpartum. Staff then provided an update on a statutorily required analysis of disproportionate share hospital (DSH) allotments, as well as an analysis of addressing high-cost drugs and the challenges they present to Medicaid.

The meeting concluded with comment on the Secretary’s report to Congress on Reducing Barriers to Furnishing Substance Use Disorder (SUD) Services Using Telehealth and Remote Patient Monitoring for Pediatric Populations under Medicaid. The Commission decided to send a letter to Congress and the Secretary commenting on this report.

Supporting the discussion were the following briefing papers:

  1. Mandated Report on Non-Emergency Medical Transportation: Work Plan and Preliminary Findings
  2. Changes in Nursing Facility Acuity Adjustment Methods
  3. Access to Mental Health Services for Adults in Medicaid
  4. Considerations in Extending Postpartum Coverage
  5. Required Annual Analysis of Disproportionate Share Hospital (DSH) Allotments
  6. Addressing High-Cost Drugs and Pipeline Analysis
  7. Comment on Secretary’s Report to Congress on Reducing Barriers to Substance Use Disorder Services Using Telehealth for Pediatric Populations under Medicaid

Because they serve so many Medicaid and CHIP patients – more than the typical hospital – MACPAC’s deliberations are especially important to private safety-net hospitals.

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.  Find its web site here.