January 2022 Public Meeting

The January 2022 MACPAC meeting began with a continuation of the Commission’s discussion on the strengthening requirements and expectations for monitoring access to care for Medicaid beneficiaries. In prior meetings, the Commission discussed the data available to monitor access, options for improving the data gaps and limitations, considerations for designing and implementing a new monitoring system, and the goals and key elements of an effective access monitoring system. The presentation reiterated the goals and key elements of a new access monitoring system and outlined seven potential recommendations for the Commission’s consideration, with the goal of making recommendations in the June report to Congress.

Next, staff presented a draft chapter on vaccine coverage and access for adults enrolled in Medicaid and shared policy options for future work. The Commission first began exploring issues related to vaccine coverage and access in September 2020. The presentation began with an overview of the draft chapter for the March report to Congress, the role of vaccines in promoting public health, and Medicaid coverage requirements for recommended vaccines. Next, it described vaccination rates in Medicaid and highlights several considerations to improve vaccine access for Medicaid enrollees. The presentation also highlighted alternative policy options for improving vaccination rates for adults enrolled in Medicaid, and the potential effects of these options on vaccination rates, racial disparities, and spending, along with the operational complexity of implementing these policies.

After a break, the Commission heard a panel discussion about Medicaid eligibility redeterminations once the current COVID-19 public health emergency (PHE) ends. Although the PHE remains in effect and states receiving the pandemic-related 6.2 percentage point increase in the federal medical assistance percentage cannot disenroll beneficiaries, federal and state Medicaid officials have been planning for the resumption of redeterminations for some time. Panelists Melissa McChesney, health policy advisor at UnidosUS; Jeff Nelson, bureau director of eligibility policy for the Utah Department of Health; and Jeremy Vandehey, director of the health policy and analytics division for the Oregon Health Authority, focused on challenges as they plan for the eventual return to routine Medicaid eligibility renewals, and the concerns of beneficiary advocates. The panel also discussed strategies states are or could be using to mitigate unnecessary coverage losses.

The Commission then continued its discussion of how to raise the bar on integrated care for people who are dually eligible for Medicaid and Medicare. In 2020, 12.3 million individuals were dually eligible for these programs; most individuals are eligible for full Medicaid benefits. However, only about 10 percent of dually eligible beneficiaries were enrolled in integrated care models in 2019. Building on the discussion in October 2021, the Commission discussed an incremental approach that starts with requiring each state to develop an integrated care strategy.

The presentation outlined two potential policy recommendations for inclusion in MACPAC’s June report to Congress. The first recommendation would require each state to develop a strategy. The second recommendation would provide additional federal funding to support states in developing the strategy. The presentation also discusses key components of an integrated care strategy for the Commission’s consideration.

Next, the Commission discussed a notice of proposed rulemaking from the Centers for Medicare & Medicaid Services (CMS) that would revise Medicare Advantage (MA) and Medicare Part D regulations, including regulations governing dual eligible special needs plans (D-SNPs). About 3 million dually eligible beneficiaries are enrolled in MA D-SNPs, which are present in 43 states. Most D-SNPs only meet the basic requirements to coordinate care, providing minimal integration of the Medicare and Medicaid programs. One of CMS’s stated purposes for the proposed rule is improving integration of Medicaid and Medicare coverage for people enrolled in those plans. Medicare-Medicaid plans (MMPs), established under the Financial Alignment Initiative, are prominent in the proposed rule. CMS proposes that a number of MMP features be applied to D-SNPs. If the proposed rule becomes final, CMS suggests that MMPs convert to D-SNPs. This presentation focused on areas for Commissioners to consider for potential comment. Next steps for staff include incorporating feedback from the discussion and drafting a comment letter.

On Friday, staff presented an overview of a draft chapter for inclusion in the March report to Congress on the Money Follows the Person (MFP) demonstration, which has provided participating states with flexibility and enhanced funding to support transitioning over 100,000 Medicaid beneficiaries from institutional settings back to the community. MFP participants must be transitioned into specific settings, using a much narrower definition than permitted by the home- and community-based services (HCBS) settings rule. The Consolidated Appropriations Act, 2021 (CAA, P.L. 116-260) directed MACPAC to identify settings that are available to MFP participants and the settings that qualify for HCBS payment under the settings rule. Furthermore, if appropriate, Congress has requested the Commission recommend policies that would align MFP residence criteria with the HCBS settings rule.

After lengthy discussion over the past few months about the advantages and disadvantages of the existing MFP qualified residence criteria and potential implications of changes, the Commission concluded that there is not sufficient evidence to support aligning MFP residence criteria with the HCBS settings rule. Thus, the draft chapter for the March report to Congress outlines the advantages and disadvantages of the current criteria as informed by stakeholder perspectives.

The meeting concluded with a panel discussion on bringing the beneficiary voice into Medicaid and State Children’s Health Insurance Program (CHIP) policymaking. Kate McEvoy, program officer at the Milbank Memorial Fund and former Medicaid and CHIP director in Connecticut, provided suggestions on developing standing means of beneficiary engagement to ensure a more continuous feedback loop. Cara Stewart, director of policy advocacy at Kentucky Voices for Health, shared experiences working as a connector between community-based organizations and the state Medicaid agency. Cathy Simone, a member of the Commonwealth Care Alliance health plan and participant on its consumer advisory council, shared her first-hand perspective on beneficiary engagement.

Presentations