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MACPAC Releases June Report to Congress

June 28, 2013—The Medicaid and CHIP (Children’s Health Insurance Program) Payment and Access Commission (MACPAC) June 14 released its sixth report to Congress. The report examines the increase in Medicaid physician payment for primary care services, Medicaid and CHIP eligibility and coverage for maternity services, access to care for persons with disabilities, and oversight and integrity issues, among other topics.

The commissioners examined the status of the physician primary care payment increase, which will be implemented in 2013 and 2014. The increase applies to services delivered by physicians paid under fee-for-service arrangements and by Medicaid managed care organizations (MCOs). MACPAC conducted interviews with six states and the District of Columbia, providers, and MCOs for this survey. The interviewees expressed concerns about the time allotted to implement the payment increase and the effectiveness of increasing Medicaid participation, since the provision expires after 2014. The report presents questions to policymakers about how the payment increase will affect physician participation and enrollee access to care and how this knowledge can be used to develop future policy.

The commissioners also highlighted maternal care policies and spending under the Medicaid and CHIP programs. In 2010, Medicaid and CHIP paid for almost 50 percent of all births in the country. States are required to provide pregnancy-related coverage to pregnant women up to 133 percent of the federal poverty level (FPL); however, all but nine states have extended coverage to pregnant women above that level. For pregnant women, services covered under Medicaid and CHIP range from full Medicaid benefits (69 percent of Medicaid-covered births in 2008) to coverage of only pregnancy-related services (those necessary for the health of the pregnant woman and fetus) to emergency services only (for certain non-citizens).

The federal government has substantial leverage to influence the delivery of care and is using this power to reduce Cesarean sections (C-sections), which occur in approximately one-third of all Medicaid deliveries. C-sections cost more than vaginal deliveries and are associated with more adverse outcomes. Many states, in partnership with the federal government and private organizations, have initiated programs to reduce elective C-sections and non-medically indicated induced deliveries before 39 weeks gestation.

The commission will reconvene in September.


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


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