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MACPAC Issues Seven Recommendations to Congress in March Report

December 20, 2013—The Medicaid and Children’s Health Insurance Program (CHIP) Payment and Access Commission (MACPAC) Dec. 12-13 met to finalize chapters and issue recommendations for its March report to Congress. The commission voted to include seven recommendations to Congress in the report.

One chapter of the report will focus on CHIP, which is currently undergoing a transition since the parents of many children enrolled in the program will begin receiving subsidized coverage through the new health insurance marketplaces created under the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152). The commission voted to make two recommendations to Congress that are intended to expand access to CHIP: to eliminate CHIP waiting periods and eliminate CHIP premiums for children with family incomes below 150 percent of the federal poverty level.

The report will include a chapter on “churning,” which occurs when individuals enroll and disenroll in different sources of insurance, or lose their insurance, over a short period of time due to small income changes.

In order to reduce churning and promote greater stability in coverage, the commission will make two recommendations: Congress should create a statutory option for 12-month continuous eligibility for adults in Medicaid and eliminate the sunset date for extended Transitional Medical Assistance (TMA), while allowing states to opt out of TMA if they expand coverage to new Medicaid-eligible adults. MACPAC included both of these recommendations in its 2013 March report to Congress [see Washington Highlights, Feb. 15].

Also included in the March report will be a chapter on Medicaid non-disproportionate share hospital (DSH) supplemental payments. To improve transparency and facilitate Medicaid payment analysis, MACPAC will recommend that the Secretary of Health and Human Services (HHS) should collect non-DSH (upper payment limit) supplemental payment data at the provider level and make those data publicly available.

Additionally, there will be a chapter in the report on pregnancy coverage under Medicaid and marketplace plans. To align coverage for pregnant women, the commission will recommend that Congress should require that states provide the same benefits to women who are eligible for Medicaid on the basis of their pregnancy that are furnished to women whose Medicaid eligibility is based on their status as parents of dependent children. The commission also voted to recommend that the HHS and Treasury secretaries should specify that pregnancy-related Medicaid coverage does not constitute minimum essential coverage in cases involved women enrolled in qualified health plans.

The March report also will include chapters on:

  • Medicaid and CHIP in the context of the ACA;
  • Program integrity concerns with Medicaid eligibility changes under the ACA;
  • Medicaid’s role in providing long-term service and supports to vulnerable populations; and
  • Medicaid and CHIP statistics (MACStats).

The next MACPAC meeting will be Jan. 23-24.


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