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MACPAC Discusses Priorities for 2014

September 27, 2013—The Medicaid and CHIP (Children’s Health Insurance Program) Payment and Access Commission (MACPAC) Sept. 19-20 convened to discuss its priorities for 2013-2014.

Over the next year, the commission will focus on five key issues:

  • children’s health and the future of the CHIP program;
  • the implementation of the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152);
  • Medicaid and CHIP cost containment;
  • Medicaid’s role in high-need populations; and
  • using data to improve Medicaid administration.

The commission expects to make additional recommendations in 2014, and aims to make the MACPAC website a more comprehensive resource for Medicaid-related information. 

The meeting started with a presentation from MACPAC staff on ACA implementation that highlighted several issues the commission will monitor. The commission will examine the extent and characteristics of churning, as 35 percent of low-income adults are projected to experience a change in income within six months that would impact their eligibility. MACPAC will monitor the effect of new Medicaid and CHIP eligibility standards tied to the Modified Adjusted Gross Income (MAGI) and estimate the number of people with eligibility changes.

Additionally, the commission will study factors affecting private insurers that participate in both the Medicaid and exchange markets and assess the impact of multi-market plan participation.

The commissioners also discussed non-federal financing and supplemental payments that are used to pay for state Medicaid programs. The commission is taking a deeper look into states’ use of supplemental payments and health care related taxes, with the goal of providing additional transparency for policymakers on these funding streams. In fiscal year (FY) 2013, all 50 states utilized at least one Medicaid provider tax, with most targeting nursing homes and inpatient hospitals.

MACPAC staff examined five states to present a snapshot of current state practices. In their analysis, staff determined that four of the five states made significant supplemental payments to hospitals and four states implemented health care related taxes.

In addition to these taxes, staff also highlighted the use of intergovernmental transfers (IGTs) and certified public expenditures (CPEs). Commissioners expressed interest in determining what portion of provider payments come from IGTs and CPEs, how managed care spending is affected by these payments, and additional clarity on how states pay providers under Medicaid, among other issues.

The next MACPAC meeting will be Oct. 17-18.


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