March 18, 2021

MACPAC Releases March 2021 Report on Medicaid and CHIP to Congress

On March 15, 2021, The Medicaid and CHIP Payment and Access Commission (MACPAC) released its March 2021 Report to Congress on Medicaid and CHIP, this five-chapter report recommends that Congress adopt measures aimed at improving Medicaid’s responsiveness during economic downturns, addressing concerns about high rates of maternal morbidity and mortality and re-examining Medicaid’s estate recovery policies. The report also contains additional topics of interest to Congress, such as integrating care for people who are dually eligible for Medicaid and Medicare and improving hospital payment policy for the nation’s safety net hospitals.

There are two chapters relevant to American College of Radiology® (ACR®) members, Chapter 1 addresses the challenge that states face during recessions when Medicaid enrollment grows and state revenues decline. State and federal Medicaid spending supports state economies, and increases in Medicaid spending can counteract other spending reductions during a recession. If state revenue is declining, states can find it hard to finance their share of growing Medicaid expenditures.

In this chapter, the Commission recommends that Congress should amend the Social Security Act to provide an automatic Medicaid countercyclical financing model, using the prototype developed by the United States (U.S.) Government Accountability Office as the basis. This would ensure that additional federal funds flow quickly to Medicaid during economic downturns and would give states greater budget predictability.

Chapter 4 covers the Commission’s work on integrating care for individuals who are dually eligible for Medicaid and Medicare, often experiencing fragmented care and poor health outcomes due to lack of coordination across the two programs. A unified program could simplify coverage for beneficiaries, providing care and services under a single umbrella. It also has the potential to reduce federal and state spending on these individuals.

This chapter examines many of the policy and design issues and policy trade-offs that would need to be settled in developing a unified program. MACPAC draws on the work of two stakeholder groups — the Bipartisan Policy Center and the Dual Eligible Coalition convened by Leavitt Partners — that are promoting a new approach to serving this population. In this chapter, the Commission examines key design considerations that would have to be addressed to establish a unified program. The chapter begins with background on existing integrated care models, then offers specific policy considerations for issues related to eligibility, beneficiary protections and enrollment, benefits, delivery system and care coordination, administration, and financing. The Commission is continuing its work on more immediate ways to improve integration of care for dually eligible beneficiaries and will provide additional insights in its June 2021 report to Congress.

Based on the Commission’s meeting in March, its June report will examine strategies to improve access to vaccines in general for Medicaid-enrolled adults, including provider payment rates and data collection and reporting of vaccination information, and will discuss recommendations to address high-cost specialty drugs under the Medicaid Drug Rebate Program, lessons from the Medicaid Innovation Accelerator Program and future issues facing the U.S. territories.

Overall, MACPAC provides policy and data analysis that assist in making recommendations to Congress, Secretary of the Department of Health and Human Services, and the states on issues affecting Medicaid and CHIP. It is required by statute to submit reports to Congress by March 15 and June 15 annually.

The next MACPAC meeting will be will be held April 8 to 9, 2021. All MACPC meetings are open to the public and held virtually. Visit the MACPAC site for meeting details.

Your questions about the report may be directed to ACR Economics and Health Policy staff Alicia Blakey or Christina Berry.