The Medicaid and CHIP Payment and Access Commission (MACPAC) released its March 2022 Report to Congress on March 15. The report focused on transitioning Medicaid beneficiaries out of institutions and back into the community under the Money Follows the Person (MFP) program, improving vaccination rates and access for adults enrolled in Medicaid, and assessing hospital payment policy for the nation’s safety-net hospitals.
In the Consolidated Appropriations Act, 2021 (P.L. 116-260), Congress mandated that MACPAC study the MFP program, specifically comparing the MFP residence criteria — which requires participants to be transitioned into specific settings — to the more expansive settings permitted under home- and community-based services (HCBS). Congress directed MACPAC to identify settings that are available to MFP participants and the settings that qualify for HCBS payment under the settings rule. The MFP program provided participating states with flexibility and enhanced funding to support more than 100,000 Medicaid beneficiaries who transition from institutional settings back to the community. The commission concluded that there was not enough empirical data to support a recommendation to harmonize the MFP residence criteria with the HCBS settings rule.
The report also looked at vaccine access for adults enrolled in Medicaid. These beneficiaries typically have lower vaccination rates than those covered by private insurance across nearly all vaccines, in large part due to limited coverage. Limited provider access and availability and inadequate support and education for beneficiaries also contributed to low vaccination rates. The commission highlighted several policy considerations to improve vaccine access for Medicaid beneficiaries and noted that it will continue to evaluate options and perhaps offer recommendations in its June report.
Finally, the report included a chapter on Medicaid disproportionate share hospital (DSH) allotments to states. The report highlighted the impact of the COVID-19 pandemic on hospital finances but noted that the full effect on safety-net hospitals and DSH hospitals will not be fully evident until after the public health emergency ends. As with previous DSH reports, the commission found little meaningful relationship between DSH allotments to states and the number of insured individuals, the amount and resources of hospitals’ uncompensated care costs, and the number of hospitals with high levels of uncompensated care that also provide essential community services for low-income, uninsured, and vulnerable populations.