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Washington Highlights

MACPAC Releases June Report to Congress

June 16, 2017—The Medicaid and CHIP Payment Advisory Commission (MACPAC) June 15 released its June 2017 Report to Congress, which includes an analysis of mandatory and optional enrollees and services in Medicaid, how state Medicaid programs are responding to the opioid epidemic, and an examination of program integrity activities in Medicaid managed care.

The first chapter responds to a request from Senate Finance Committee Chair Orrin Hatch (R-Utah), House Energy and Commerce Chair Greg Walden (R-Ore.), House Energy and Commerce Health Subcommittee Chair Michael Burgess (R-Texas), and House Energy and Commerce Oversight and Investigations Subcommittee Chair Tim Murphy (R-Penn.) for the commission to examine Medicaid enrollment of and spending on mandatory and optional populations and services. MACPAC’s analysis finds that in fiscal year (FY) 2013, almost half of Medicaid benefit spending was on mandatory populations receiving mandatory services, and just over 20 percent of spending was for mandatory populations receiving optional services. The largest share of both mandatory and optional spending was for people eligible on the basis of disability.

The June Report also describes how state Medicaid programs are responding to the opioid epidemic, which disproportionately affects Medicaid beneficiaries. The report finds that compared to people with other sources of insurance, adults with Medicaid coverage are prescribed pain relievers at a higher rate and have a higher rate of opioid use disorder but also have higher treatment rates. In response to this, state Medicaid programs are covering treatment, innovating in the delivery of care, and using Section 1115 waivers to expand the availability of treatment and the number of individuals eligible for care. The report highlights several barriers to care, including a lack of providers, difficulty securing timely appointments, and a fragmented and poorly funded delivery system.

The final chapter of the June Report focuses on program integrity in Medicaid managed care, which is now the primary Medicaid delivery system and accounts for nearly half of federal and state spending on Medicaid. The commission’s analysis identified a need for states to better coordinate their managed care oversight functions and their program integrity functions, as well as to collect better data on managed care encounters. Based on findings from interviews with stakeholders, the commission found that its 2012 recommendations remain relevant for managed care, but it may examine other areas of program integrity in the future.


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


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