The April 2024 Commission meeting began with a presentation of a draft chapter on demographic data collection in Medicaid for the June Report to Congress. Racial and ethnic health disparities persist throughout the U.S. health care system. Previous meetings have focused on the collection of primary language and limited English proficiency, sexual orientation and gender identity (SOGI), and disability data to help assess and address these health disparities. Measuring differences in access and use of services, as well as experience and satisfaction of behavioral and mental health care, can help to better understand the underlying causes of disparities. This work is a continuation of the Commission’s March 2023 recommendations for improving race and ethnicity data.
During this discussion, staff presented on the need to collect these types of demographic data, Medicaid administrative and federal survey data availability, data limitations, and key considerations for collecting these data.
Next, the Commission discussed policy options to improve the transparency of financing in Medicaid and the State Children’s Health Insurance Program (CHIP). Following up on the Commission’s discussion at the December 2023 Public Meeting, staff presented on transparency of financing the non-federal share of Medicaid and CHIP. Staff presented a draft chapter and recommendations to collect and publicly report information on the sources of non-federal share, including financing methods, state-level financing amounts, and provider-level financing amounts. On Friday, the Commission voted to approve those recommendations.
After a break, the Commission previewed a draft chapter on state Medicaid agency contracts (SMACs) and how states can optimize and oversee these contracts with Medicare Advantage (MA) dual eligible special needs plans (D-SNPs). Over the past year, staff have reviewed SMACs and interviewed stakeholders about the tools and requirements that state Medicaid agencies have for overseeing their contracts with D-SNPs. The chapter describes findings from this work, in addition to highlighting how states face barriers to overseeing their SMACs that reflect broader challenges that prior Commission recommendations on integrated care for dually eligible individuals sought to address.
The chapter concludes with two recommendations, one made to states and one made to the Centers for Medicare & Medicaid Services, that are intended to support states by providing a starting point for optimizing and overseeing SMACs and to explain how integrated care may benefit beneficiaries residing in their states. On Friday, the Commission voted to approve those recommendations.
Next, the Commission reviewed findings from an environmental scan of all 50 states and the District of Columbia on policies that affect individuals’ timely access to home- and community-based services (HCBS). Timely access to HCBS is essential to ensure individuals receive care in the setting of their choice. To receive HCBS, individuals must undergo a multi-step eligibility and enrollment process that includes an eligibility determination based on financial and functional eligibility criteria and the development of a person-centered service plan (PCSP). States have a number of options available to streamline Medicaid enrollment for people in need of HCBS, such as presumptive eligibility, expedited eligibility, and setting timeline requirements for completing level of care assessments and developing PCSPs.
The Commission then discussed a long-term work plan for examining all types of Medicaid payments to hospitals, including disproportionate share hospital (DSH) payments, non-DSH supplemental payments, and managed care directed payments. This session provided an overview on staff findings from a preliminary review of supplemental payment targeting methods and the targeting of non-DSH supplemental payments using new provider-level data that states are required to report under the Consolidated Appropriations Act, 2021 (CAA, P.L. 116-220). The Commission also discussed policy principles, and future work in this area.
On Friday, the Commission heard from a panel of panel of researchers who shared their perspectives and lessons learned from the unwinding of the continuous coverage requirements in Medicaid. The Commission is shifting its focus to what can be learned from the unwinding process and areas for future research. Panelists included:
- Genevieve Kenney, Vice President and Senior Fellow, Urban Institute Health Policy Center
- Daniel Meuse, Deputy Director, State Health & Value Strategies
- Jennifer Tolbert, Deputy Director, KFF Program on Medicaid & Uninsured
