The Medicaid and CHIP Payment and Access Commission (MACPAC)

David Sundwall, MD

Vice Chair

Presentation Overview

• MACPAC Charge and Overview

• June 2013 and March 2014 Reports

• Preview of the June 2014 Report

• Looking Ahead

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MACPAC Statutory ChargeLegislative History

• Established in February 2009 (Children’s Health Insurance Program Reauthorization Act)

• Expanded and funded in March 2010 (Patient Protection and Affordable Care Act)

Commission

• Appointed by the Comptroller General of the United States to 3-year terms

• 17 Commissioners represent broad spectrum of interests and expertise on Medicaid and CHIP

Goals

• Serve as a federal non-partisan and analytic resource on Medicaid and CHIP policy for the Congress

• Review and make recommendations on federal and state Medicaid and CHIP policies and data sources

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MACPAC Duties

• Review Medicaid and CHIP policy issues:– Payment policies

– Access to care Eligibility and enrollment

– Benefits and coverage policies

– Quality of care

– Interactions with Medicare and health care system

– Data to support policy analysis and program accountability

• Submit annual reports to the Congress in March and June

• Review and comment on Secretarial reports and regulations that relate to Medicaid and CHIP

• Collaborate and consult with states, MedPAC, and the Medicare-Medicaid Coordination Office

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Current MACPAC Commissioners

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Chair: Diane Rowland, ScDVice Chair: David Sundwall, MD

•Sharon L. Carte, MHS •Mark Hoyt, FSA, MAAA

•Richard Chambers •Norma Martinez Rogers, PhD, RN, FAAN

•Donna Checkett, MPA, MSW •Judith Moore

•Andrea Cohen, JD •Trish Riley, MS

•Burton L. Edelstein, DDS, MPH •Sara Rosenbaum, JD

•Patricia Gabow, MD •Robin Smith

•Herman Gray, MD, MBA •Steven Waldren, MD, MS

•Denise Henning, CNM, MSN

June 2013 Report to the Congress on Medicaid and CHIP

• Chapter 1: Maternity Services: Examining Eligibility and Coverage in Medicaid and CHIP

• Chapter 2: Medicaid Primary Care Physician Payment Increase

• Chapter 3: Access to Care for Persons with Disabilities

• Chapter 4: Update on Medicaid and CHIP Data for Policy Analysis and Program Accountability

• Chapter 5 Update on Program Integrity in Medicaid

• MACStats

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March 2014 Report to the Congress on Medicaid and CHIP

• Chapter 1: Medicaid and CHIP in the Context of the ACA

• Chapter 2: Promoting Continuity of Medicaid Coverage among Adults under Age 65

– Affirmed previous MACPAC recommendations to allow states to provide 12-month continuous eligibility to adults, to end sunset date for Transitional Medicaid Assistance (TMA), and to allow states expanding to the new adult group to opt out of TMA

• Chapter 3: Issues in Pregnancy Coverage under Medicaid and Exchange Plans

– Recommended same coverage for pregnancy-related eligible women as that provided to women eligible through other eligibility pathways

– Companion recommendation that women enrolled in exchange plans should be allowed to retain that coverage even if pregnancy makes them eligible for Medicaid7

March 2014 Report to the Congress on Medicaid and CHIP, cont.

• Chapter 4: ACA Eligibility Changes: Program Integrity Issues

• Chapter 5: Children’s Coverage under CHIP and Exchange Plans

– Recommended that children in CHIP not be subject to waiting periods

– Recommended ending CHIP premiums for children with family incomes below 150 percent FPL

• Chapter 6: Examining the Policy Implications of Medicaid Non-Disproportionate Share Hospital Supplemental Payments

– Recommended that the DHHS Secretary collect provider-level non-DSH supplemental payment data

• MACStats8

Medicaid and CHIP Program Statistics: MACStats

• Original MACPAC state and national-level data analysis included in all MACPAC Reports to the Congress

• June MACStats provide information on:

– Trends in Medicaid spending, enrollment and population characteristics

– Medicaid enrollment by state, eligibility group, and dual eligible status

– Medicaid enrollment and spending in Medicaid managed care

• Selected March 2014 MACStats tables included:

– Medicaid and CHIP enrollment

– Medicaid spending by category, total benefits and source of funds

– Medicaid as a share of states’ total budgets and state-funded budgets

– Access to care measures for Medicaid and CHIP populations

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June 2014 Report to the Congress: Preview

• The future of CHIP and federally subsidized children’s coverage

• Medicaid’s role in providing long-term services and supports

• Medicaid’s role in promoting population health • Administrative capacity of state Medicaid programs• MACStats

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Looking Ahead

• Additional areas of focus throughout 2014 may include:• The future of CHIP

• ACA implementation and issues related to coordination with health exchanges, including focus groups with new enrollees

• Long-term service and support (LTSS) analyses including managed LTSS and issues related to setting capitation rates

• Advanced payment models

• Impact of primary care fee bump

• Access to specialty care

• Documenting payment methodologies for different types of providers

• Program integrity and administrative capacity

• For all questions, and detailed information, go to www.macpac.gov .

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