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Washington Highlights

MACPAC Discusses Issues for March Report to Congress

November 30, 2012—The Medicaid and CHIP (Children’s Health Insurance Program) Payment and Access Commission (MACPAC) convened Nov. 15 to discuss key issues for their March Report to Congress. The commission discussed a range of issues including health care delivery system challenges for Medicaid beneficiaries with disabilities, Medicaid primary care physician payments, exchange interactions for Medicaid and CHIP enrollees, and the Medicaid/Medicare dually eligible population.

The commission started the day-long meeting with a panel that explored service delivery challenges and opportunities to inform the commission’s work on promising models of care, payment, and access for persons with disabilities. The panelists included Barbara Otto, CEO, Health & Disability Advocates; Elena Nicolella, Medicaid director, Rhode Island Department of Human Services; and John Matthewson, executive vice president, Strategy and Operations, the HSC Foundation. In addition to highlighting challenges, the panelists addressed how provisions within the Affordable Care Act (ACA, P.L. 111-148, P.L. 111-152) may impact access and delivery of care to enrollees with disabilities.

The meeting continued with an update on Medicaid payments for primary care services in 2013 and 2014. The commission reviewed the statutory requirements for Medicaid payments for these services, which requires states to pay at least 100 percent of Medicare rates for primary care services by a physician with specified specialty or subspecialty in 2013 and 2014. The commission is in the process of surveying stakeholders in eight states to assess implementation and evaluation planning.

During the afternoon session, the commission discussed the implications of Medicaid and CHIP enrollees on health insurance exchanges. This issue will be addressed in MACPAC’s March Report to Congress. Specifically, the commission reviewed concerns pertaining to churning (individuals moving between Medicaid, CHIP, and coverage through an exchange), transitional medical assistance (continuation of insurance for low-income parents whose income has increased), possibly allowing Medicaid as a supplemental insurance, and addressing variation in Medicaid benefits among low-income adults.

Finally, commission members discussed policy initiatives to improve the quality of care, while lowering costs, for the dual-eligible population. MACPAC staff highlighted state-level demonstration projects that incorporated integrated service delivery and risk-based financing approaches, along with care and disease management approaches for dual-eligibles. Additional information is available on the MACPAC website.


Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806

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


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Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806