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Washington Highlights

MACPAC Releases June 2014 Report to Congress

June 20, 2014— The Medicaid and CHIP (Children’s Health Insurance Program) Payment and Access Commission (MACPAC) June 13 released its June 2014 Report to Congress. The report focuses on the future of CHIP, Medicaid’s role in providing assistance with long-term services and supports (LTSS), efforts to promote population health, and administrative capacity to meet growing responsibilities.

Under current law, CHIP funding is scheduled to run out shortly after fiscal year (FY) 2015. At its April meeting, the commissioners discussed several options on how to deal with the program’s future [see Washington Highlights, April 11]. They considered everything from allowing funding to expire, which would force many children now served by CHIP to find coverage elsewhere, to providing funding for CHIP indefinitely.

In the June report, the commissioners issued a formal recommendation to extend federal funding for CHIP for a transition period of two additional years. Without an extension, the commission warns that the number of insured children would increase significantly, cost sharing for services would increase substantially for many families, and the exchange plans may not be ready to serve as an appropriate alternative. 

During the two year extension, MACPAC will examine a range of issues about the design and adequacy of coverage for the CHIP population and will offer options to provide a more seamless continuum of children’s coverage that better accommodates transitions in coverage among Medicaid, the exchanges, and employer-sponsored insurance.

The second chapter of the June report is on Medicaid’s role in providing assistance with LTSS. LTSS users were only six percent of total Medicaid enrollees, but they account for almost half of all Medicaid spending. The commission will focus its future work on examining issues associated with the movement to managed LTSS, the use of home and community-based services (HCBS) waivers, and improvements in available data on LTSS needed to support policy analysis, evaluation, and future program design.

The third chapter focuses on Medicaid and population health. The report highlights that although Medicaid is primarily a source of health insurance coverage, it also covers services other payers may not cover, including counseling and education, targeted case management, and health promotion programs. The commission will continue to track population health initiatives and examine efforts to improve the overall health of Medicaid enrollees.

In the final chapter, the commission outlines a variety of capacity constraints that hinder the administration of Medicaid and CHIP, including financial disincentives to invest in program administration, increasing system demands and complexity, and difficulty recruiting and retaining expert staff. MACPAC will continue to focus on how administrative performance should be measured and which strategies are most effective in helping states develop adequate capacity.

Additional information about MACPAC, including previous reports, can be found on their website. The next MACPAC meeting is scheduled for Sept. 18-19, 2014.


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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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