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MACPAC Meets to Discuss Future of CHIP and Medicaid Supplemental Payments

November 22, 2013—The Medicaid and CHIP (Children’s Health Insurance Program) Payment and Access Commission (MACPAC) Nov. 14-15 convened to discuss the future of CHIP and Medicaid non-Disproportionate Share Hospital (DSH) supplemental payments, among other issues.

The meeting began with a panel of CHIP Directors from Alabama, Virginia, and Washington, D.C.. They each highlighted a variety of concerns about the future of CHIP, including: the impact of continued state budget cuts on coverage; the “family glitch,” which may result in a lack of coverage for children with parents who cannot afford employer-offered premiums for family coverage; and the transition of coverage from CHIP to the marketplaces, which are not as focused on children’s health.

The discussion of CHIP continued as two researchers provided the commission with additional insight. Joan Henneberry, principal at Health Management Associates, tackled the question of whether or not it is a good idea for states to let their CHIP program blend into the marketplaces. Focusing on Colorado, she concluded that it is not necessarily a good or bad idea, but that there are a number of research and policy questions that should happen in the short-term to prepare for this kind of transition.

Tricia Brooks, senior fellow at the Center for Children and Families, Georgetown University Health Policy Institute, expressed concern about the lack of federal funding for CHIP beyond FY 2015 and offered five steps that can be taken to strengthen the program: cover parents and boost enrollment; promote continuous coverage; eliminate CHIP waiting periods; invest in community engagement; and use data and incentives to drive program improvement and quality.

The first day of the meeting concluded with a presentation from MACPAC staff on short and long-term issues with CHIP. The commission focused its discussion on CHIP waiting periods and premiums. The commissioners debated possible recommendations to address these issues, but decided that additional research was needed before making any recommendations.

MACPAC’s second day highlighted concerns with Medicaid non-DSH supplemental payments to hospitals. Commissioners discussed the lack of federal data on these payments, which they argue hinders their ability to provide oversight on Medicaid payment policies. Non-DSH supplemental payments make up more than 20 percent of total Medicaid fee-for-service (FFS) hospital payments in the United States. MACPAC staff and commissioners discussed issuing a recommendation on this issue in their upcoming report. Some of the possible recommendations included:

  • Requiring the Centers for Medicare and Medicaid Services to collect non-DSH supplemental payment data at the provider level and to make this data publicly available;
  • Requiring lump-sum Non-DSH supplemental payments to be for an approved purpose consistent with the goals of the Medicaid program; and
  • Prohibiting lump-sum non-DSH supplemental payments. 

Additional information on this meeting, including all of the presentations, is available on the MACPAC website. The next meeting will be Dec. 12-13.


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