The Medicaid and CHIP Payment and Access Commission (MACPAC) met on Jan. 29 and 30 to discuss a number of topics including policy options for ensuring accountability of Medicaid MCOs, implementation of Medicaid work requirements required by the One Big Beautiful Bill Act (OBBBA, P.L. 119-21, PDF), behavioral health in Medicaid and CHIP, and automation of prior authorization in Medicaid. The findings from the analysis of behavioral health services in Medicaid and CHIP will appear in the commission’s March 2026 report to Congress, while findings from the analysis of automation of prior authorization in Medicaid will appear in the commission's June 2026 report to Congress. Commissioners further discussed the need for more information and guidance on the use of automation in prior authorization.
MACPAC commissioners also reviewed three policy options for ensuring accountability of Medicaid managed care organizations (MCOs) including allowing CMS to withhold, defer, or disallow the federal match for all or part of managed care capitation payments, provide guidance to support Managed Care Program Annual Reports (MCPAR) data accessibility and completeness, or issue guidance on how to effectively use available data to assess plan performance. Commissioners shared the most concerns with the first option and will vote on modified recommendations later this year.
Commissioners then reviewed draft principles to guide work related to implementing Medicaid work requirements required by the OBBBA. These principles include urging CMS to provide timely federal guidance and technical assistance to states; ensuring that eligible individuals can gain and maintain coverage; prioritizing efficiency when procuring, updating, and operating state information technology systems; and using timely monitoring and evaluation data to inform policy and operations. These principles will be refined and included in the June report to Congress alongside a related policy recommendation that reflects these principles.