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MACPAC Discusses March Report to Congress

January 18, 2013—The Medicaid and CHIP (Children’s Health Insurance Program) Payment and Access Commission (MACPAC) Jan. 15 and 16 reconvened to continue their discussion on potential chapters for the March report to Congress. Chapter topics include Medicaid payments to DSH hospitals, eligibility issues for Medicaid and CHIP enrollees under the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152) and future Medicaid expenditures, among other issues.

MACPAC staff provided background on current Medicaid DSH payment policies, and highlighted the reductions in DSH payments through FY 2022, which are required under the ACA and the American Taxpayer Relief Act (H.R. 8). Medicaid DSH reductions will total $500 million starting in FY 2014, and will steadily increase to a peak of $5.6 billion in FY 2019. Unless Congress takes additional action to extend the cuts, the FY 2023 Medicaid DSH payments will revert to the pre-FY-2014 level.

This chapter will review policy considerations of DSH reductions, including the treatment of states that do not expand Medicaid, and a review of state DSH payment policies. Commission members also discussed the affects of reductions on safety net providers, and the possibility of including broad recommendations for future Medicaid DSH payments in the March report. A proposed regulation on the DSH reduction methodology, required under the ACA, is expected in early 2013.

Additionally, staff discussed the outline of the Commission’s draft chapter on Medicaid and CHIP enrollee eligibility issues. This chapter will focus on the program’s future expansion in enrollees, and maintenance of effort and modified adjusted gross income requirements. The Commission also plans to make recommendations regarding concerns with churning (individuals moving between Medicaid, CHIP, and coverage through an exchange) and concerns with transitional medical assistance (continuation of insurance for low-income parents whose income has increased).

All recommendations for the March report will be finalized at the Commission’s next meeting on Feb. 12 and 13.


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


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