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MACPAC Meets to Discuss CHIP Benefits, Medicaid Payment Models, and ACA Enrollment

January 24, 2014— The Medicaid and Children’s Health Insurance Program (CHIP) Payment and Access Commission (MACPAC) Jan. 23 met to discuss a variety of topics, including new studies on CHIP benefits, advanced Medicaid payment models, and early insights in health insurance enrollment under the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152).

Two researchers provided the commissioners with overviews of new studies on CHIP benefits. Susan Anthony, assistant director, health care, U.S. Government Accountability Office (GAO), summarized a Dec. 2013 GAO report that examines coverage and consumers’ costs in separate CHIP plans compared to benchmark plans in select states. The report found that the CHIP plans were generally comparable to the benchmark plans in terms of the benefits that are offered through qualified health plans. Additionally, consumers’ costs for these services were almost always less in the CHIP plans when compared to their respective benchmark plans.

Joe Touschner, senior health policy analyst, Center for Children and Families, Georgetown University Health Policy Institute, reported on his upcoming research paper, which examines benefits and cost-sharing in separate CHIP programs. The preliminary findings show that most programs provide full coverage for mental health and substance abuse services, non-orthodontic oral health services, and prenatal care and pre-pregnancy services.

MACPAC staff provided the commissioners with an overview of the key characteristics of Medicaid managed care organizations (MCOs) to help inform the commission’s current managed care agenda. The presentation focused on the role of managed care in Medicaid and trends in enrollment and spending, including the fact that most individuals gaining eligibility in 2014 are expected to enroll in managed care. MACPAC has focused on this issue in the past — its June 2011 report was entirely on managed care and a chapter in its March 2013 report to Congress was on rate setting for integrated plans [see Washington Highlights, June 28, 2013].

MACPAC Principal Analyst Jim Teisl, State Health Access Data Assistance Center (SHADAC) Deputy Director Julie Sonier, and SHADAC Director Lynn Blewett presented on their research and analysis of Medicaid advanced payment models in Arkansas, Minnesota, Oregon, and Pennsylvania. The states each have different models that seek to contain cost growth and improve outcomes. The presenters summarized each program and identified a few common themes across the states, including:

  • State budget conditions often provided the initial impetus for Medicaid payment reform, but savings are not the only goal;

  • States are taking an active role in payment and care delivery reform beyond traditional Medicaid managed care, but changes in roles for MCOs vary by state;

  • State Medicaid payment reforms intended to influence provider behavior; and

  • One payment reform model will not fit all states.

The meeting concluded with a presentation from Michael Perry, partner, Perry Undem Research/Communication, on early insights into Medicaid enrollment in states that expanded Medicaid under the ACA. The study explored a variety of topics surrounding Medicaid and health insurance enrollment through the ACA. Focus groups with diverse populations provided key insights about these topics, including:

  • New Medicaid applicants want health insurance coverage but few knew about Medicaid expansion;

  • Many people applied for coverage to provide protection from unexpected medical bills;

  • Eligible individuals who have not yet applied for coverage lack knowledge about Medicaid and are unaware that they could qualify for free or low-cost insurance; and

  • Most people are unclear about the next steps and would like more public education and better follow-up.

 The next MACPAC meeting will be Feb. 20-21.


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


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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