The Medicaid and CHIP Payment and Access Commission (MACPAC) met on Oct. 29-30 to discuss topics, including hospital cost drivers, the implementation of community engagement requirements (also known as work requirements), drug price negotiations, and Medicare Advantage Special Needs Plans (MA SNPs) for dually eligible beneficiaries.
MACPAC reviewed drivers of hospital costs, highlighting labor, supplies, and administration as significant drivers. Prior authorization and revenue cycle management were also found to contribute to hospital costs. The commission further reviewed the impact of utilization, acuity, and site of care, specifically focusing on these trends for the Medicaid population. The commission plans to continue expanding on this work and will present additional findings in January. Commissioners then reviewed the Center for Medicare and Medicaid Innovation models targeting Medicaid and drug price negotiations that seek to impose most-favored-nation pricing. MACPAC is seeking to understand how the introduction of these policies and programs interacts with the Medicaid Drug Rebate Program (MDRP). MACPAC will continue building on this work with presentations at the December 2026 and March 2027 meetings.
A panel also provided updates on state implementation of work requirements. Medicaid leaders from Nebraska, Colorado, and Indiana shared their states’ experiences with Medicaid work requirement implementation. The panel emphasized that while work requirements are possible to implement, states will need adequate time, resources, and personnel to be successful with minimal disruption to beneficiary access to care. Lastly, MACPAC staff presented on MA SNPs for dually eligible beneficiaries, including a review of the commission’s prior work and recommendation to require all states to develop a strategy to integrate Medicaid and Medicare coverage for dually eligible beneficiaries. The commission plans to continue building on this work by conducting an analysis of the demographics and utilization in the various types of MA SNPs with a focus on the recent increase in Chronic Condition Special Needs Plan (C-SNP) enrollment following limitations on look-alike plans and other SNPs.