The Medicaid and CHIP Payment and Access Commission (MACPAC) released their March 2018 Report to Congress. The report focused specifically on managed care and telehealth, but also provided a chapter on Medicaid disproportionate share hospital (DSH) allotments, which is required by statute annually.
In the chapter on managed care, MACPAC recommended allowing all states to require all beneficiaries to enroll in Medicaid managed care, and suggested that the Section 1915(b) waiver approval and renewal period be extended from two to five years; and that Section 1915(c) waivers allow freedom of choice and selective contracting. Section 1915 waivers are intended to limit the enrollee’s choice of health care providers to those participating in the waiver. The chapter on telehealth focused on the coverage of telehealth by state Medicaid programs, noting that federal policy places relatively few restrictions on the adoption of telehealth coverage by the state Medicaid programs. The Commission noted that increased coverage of telehealth services have the potential to increase access to services, particularly in rural areas and to specialized services with limited provider supply. Additional research on the coverage of telehealth is needed.
The final chapter of the report focused on Medicaid DSH, in an effort to increase understanding of how safety-net hospitals have been affected by changes in insurance coverage. The report notes that total hospital charity care and bad debt continued to decrease, particularly in states that expanded Medicaid coverage. The Commission will be exploring opportunities to improve the targeting of DSH payments in future reports, now that the reductions have been delayed for two years.