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MACPAC Presents Priorities at September Meeting

September 28, 2012—The Medicaid and CHIP (Children’s Health Insurance Program) Payment and Access Commission (MACPAC) reconvened Sept. 20 – 21 following a summer recess to discuss their priorities for 2012-2013. Over the next nine months, the commission will continue to focus on access to care (utilization issues, oral health, access to prescription drugs), the impact of Medicaid enrollees on safety net institutions and emergency rooms, service delivery innovations, program efficiency, and payment issues, among other topics.

The commission started the meeting by reviewing current efforts by states to reduce emergency department (ED) utilization by Medicaid enrollees, which is higher than those with private insurance for both urgent and non-urgent care. However, the majority of ED visits for Medicaid patients are for either urgent or potentially serious complications. MACPAC staff presented alternative and less costly methods for lowering ED utilization including expansion of medical homes, patient navigators, non-ED after hours care programs, and nurse phone triage programs.

Katherine Baiker, a Harvard economist and Medicare Payment Advisory Commission (MedPAC) commissioner, presented two studies regarding Oregon’s Medicaid expansion and the relationship between Medicaid expansion and mortality. Baiker’s study concluded that expanding Medicaid results in significant improvements in physical and mental health as well as a decrease in all-cause mortality, but also a substantial increase in utilization costs.  This presentation was requested to better understand the future consequences of the Medicaid expansion.

On day two, MACPAC staff presented updates on their work involving dual-eligibles. MACPAC staff are currently working with MedPAC to merge Medicaid and Medicare data for duals, and are also following a Centers for Medicare and Medicaid (CMS) duals demonstration project. Dual-eligible programs, problems, and improvement recommendations will be a major focus of the commission’s March report. The commission concluded the meeting by discussing a host of Medicaid related payment issues, including the implications of the Medicaid payment matching rate for primary care physicians; Medicaid payment policies for inpatient and outpatient hospitals, nursing homes, and physicians; and an examination of disproportionate share hospital (DSH) cuts for states that do not expand Medicaid population.

Additional information is available on the MACPAC Web site. The commission’s next meeting is scheduled for Nov. 15. 


Scott Wetzel, M.P.P.
Lead, Quality Reporting
Telephone: 202-828-0495


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