The Medicaid and CHIP Payment and Access Commission (MACPAC) was
established in the Children's Health Insurance Program
Reauthorization Act of 2009, and its charge was later revised in
the Patient Protection and Affordable Care Act of 2010. MACPAC is
the first federal agency charged with providing policy and data
analysis to the Congress on Medicaid and CHIP, and for making
recommendations to the Congress and the Secretary of the U.S.
Department of Health and Human Services on a wide range of issues
affecting these programs. The Commission conducts independent
policy analysis and health services research on key Medicaid and
CHIP topics, including but not limited to: eligibility, enrollment,
and benefits; payment; access to care; quality of care;
interactions of Medicaid and CHIP with Medicare and the health care
system generally; and data development to support policy analysis
and program accountability. As required in its statutory charge,
the Commission will submit reports to the Congress on March 15 and
June 15 of each year. As applicable, each member of the Commission
will vote on recommendations contained in the reports. The
Commission's reports provide the Congress with a better
understanding of the Medicaid and CHIP programs, their roles in the
U.S. health care system, and the key policy and data issues
outlined in the Commission's statutory charge. This report, the
Commission's fifth since its inaugural report in 2011, is delivered
to the Congress as the federal government and states are working to
implement the Patient Protection and Affordable Care Act (ACA)
while improving Medicaid and CHIP for the people already enrolled.
In 2013, key priorities for program administrators include
implementing Medicaid eligibility provisions; managing the policy
and operational interactions among Medicaid, CHIP, and coverage
through new health insurance exchanges; and pursuing delivery
system and payment innovations for individuals dually enrolled in
Medicare and Medicaid, who are among the highest need and highest
cost enrollees in both programs. This report advances MACPAC's work
for the Congress in these areas. There are a number of eligibility
issues among Medicaid, CHIP and coverage through health insurance
exchanges that present challenges for program administrators. The
Commission examined those issues and offers recommendations to the
Congress to address how the programs will interact. If enacted, the
recommendations would improve enrollment stability and better align
a current Medicaid program known as Transitional Medical Assistance
with new provisions enacted by the ACA. As implementation of the
ACA continues to unfold, MACPAC will look at broader interactions
among Medicaid, CHIP and exchange coverage for potential program
improvements. This report also continues the Commission's work on
persons dually eligible for Medicare and Medicaid, a group that is
of great interest to the Congress because of the complexity and
cost of their needs. To improve service delivery and moderate
costs, the Commission highlights the necessity of pursuing policy
approaches that are targeted to the subpopulations covered by both
Medicare and Medicaid. Medicaid payment for Medicare cost sharing
is also examined in this report, including results from a new
MACPAC analysis that examines states' Medicaid payment policies for
Medicare cost sharing and interactions with Medicare bad debt
policy. And, the report explores how Medicaid pays managed care
plans for dual-eligible enrollees, an important issue as more
states seek to enroll persons covered by both Medicare and Medicaid
in these plans.
General
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