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MACPAC Finalizes Chapters for June Report

May 24, 2013—The Medicaid and CHIP (Children’s Health Insurance Program) Payment and Access Commission (MACPAC) May 16-17 convened to discuss health insurance marketplaces, Medicaid waivers, a proposed rule on disproportionate share hospitals (DSH) reductions, and its June report to Congress. The June report will cover a variety of topics, including the two-year primary care payment increase, waivers, maternity care, and program integrity, among other issues.

MACPAC’s first day of meetings began with a presentation on the health insurance marketplaces from Chiquita Brooks-LaSure, deputy director for policy regulation, Center for Consumer Information and Insurance Oversight (CCIIO). She provided the commissioners with a status update on the marketplaces, which will begin open enrollment on Oct. 1, 2013, with coverage available starting Jan. 1, 2014. She also informed the group that a final rule on navigators will be released this summer.

The meetings continued with presentations on the federal and state perspectives of Medicaid waivers. Cindy Mann, deputy administrator and director, Center for Medicaid and CHIP Services, Centers for Medicare and Medicaid Services (CMS), provided the commissioners with an overview of 1115, 1915(b), and 1915(c) waivers and how CMS is working to make these waivers simpler and more transparent. A second panel composed of officials from New Jersey and Arizona shared their experiences on what works with these waivers and provided suggestions for possible improvements.

On day two, MACPAC staff and commissioners discussed the maternity eligibility and coverage chapter for the June report and the Medicaid DSH allotment reductions proposed rule [see Washington Highlights, May 17]. Staff reviewed the different data sources for tracking births, and highlighted the total number of babies born to women enrolled in Medicaid and the total Medicaid spending for maternity care. In 2010, there were approximately 2 million births to women enrolled in Medicaid or CHIP, with the total cost of these deliveries estimated at $7.1 billion.

Lastly, the commission discussed the Medicaid DSH proposed rule. The Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152) requires cuts in DSH payments through 2020, which were extended an additional two years with subsequent legislation. The proposed methodology for implementing the cuts will apply to state DSH allotments annually for FYs 2014 and 2015, to allow for a future assessment of the Medicaid expansion. 

MACPAC’s next report will be released June 15.


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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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.

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