MACPAC Reviews Work Requirements, Prior Authorization, and Program Integrity  

The Medicaid and CHIP Payment and Access Commission (MACPAC) met on April 9 and 10 to discuss topics including the implementation of work requirements, automation in prior authorization, Medicaid program integrity, and pharmacy benefit managers.  

Commissioners began the meeting by reviewing a draft recommendation on the implementation of community engagement (or work requirements), which commissioners will vote on next month for inclusion in the June 2026 report to Congress. The draft recommendation directs the Centers for Medicare and Medicaid Services (CMS) to develop a plan for monitoring and evaluating community engagement requirements in Medicaid and to allow for transparency through the timely publication of state reporting, monitoring, and evaluation results while minimizing administrative burden. MACPAC continued its evaluation of the automation of prior authorization and reviewed four draft recommendations to ensure a human with the appropriate expertise is in the loop, and that there is adequate oversight and reporting of automation tools in plans’ coverage and prior authorization processes. The commission will include a chapter on automation in prior authorization in its June 2026 report to Congress. Lastly, commissioners reviewed the role of pharmacy benefit managers, including recent legislative changes at the federal and state levels. MACPAC plans to publish an issue brief on the topic in the future.   

During the Friday session, commissioners voted and supported a recommendation to direct CMS to provide guidance on how to report accountability actions in the Managed Care Program Annual Report. Lastly, commissioners reviewed fraud, waste, and abuse in Medicaid, finding that while this may account for a small portion of program spending, the scale and impact are difficult to quantify. MACPAC identified federal-state collaboration and program integrity in managed care as areas for additional investigation. MACPAC staff will return next cycle with additional findings following stakeholder interviews.