The Medicaid and CHIP Payment and Access Commission (MACPAC) met May 7 to discuss topics including the implementation of community engagement requirements (also known as work requirements) and automation in prior authorization, as well as vote on recommendations for the commission’s June report to Congress.
Commissioners began the meeting with a presentation of four draft recommendations for the use of automation for prior authorization requests in Medicaid. Recommendations are based on a set of policy principles that highlight the administrative efficiencies automation provides for payers and providers, the need for transparency and disclosure to assess the use and risk of automation, and the need for ongoing reevaluation of oversight policy. The four recommendations presented would clarify federal requirements for oversight of prior authorization processes, ensure oversight of prior authorization processes in Medicaid Fee-For-Service, urge the Centers for Medicare & Medicaid Services (CMS) to issue guidance to states and Medicaid plans on oversight of automation in prior authorization, and increase transparency into managed care plans’ use of automation. Commissioners also reviewed a draft recommendation on implementing community engagement requirements in Medicaid. This recommendation would direct the CMS to develop a transparent plan for monitoring and evaluating community engagement requirements in Medicaid based on stakeholder input to make public a plan with meaningful metrics for tracking eligibility and enrollment.
The MACPAC commissioners unanimously voted in support of the four recommendations related to automation in prior authorization. However, in the vote for the draft recommendation on implementing community engagement requirements in Medicaid, 15 commissioners voted in favor and two voted against the recommendation. These recommendations will appear in MACPAC’s June 2026 report to Congress.