September 2021 Public Meeting

The September 2021 MACPAC meeting opened with a brief presentation from MACPAC Executive Director Anne L. Schwartz, who outlined the topics the Commission will be taking up during the 2021-2022 report cycle, as well as how stakeholders can engage with the Commission’s work.

Next, staff shared findings from focus groups conducted with PerryUndem, as well as stakeholder interviews to better understand the needs and preferences of beneficiaries in communicating with state Medicaid programs. Medicaid beneficiaries preferred multiple options to connect with state Medicaid programs to apply for and renew coverage. State capacity for making improvements differs, but all states face constraints in adopting new technologies.

The Commission then heard a staff presentation summarizing MACPAC’s analyses of enrollment data from the Transformed Medicaid Statistical Information System (T-MSIS) and the extent to which state variation in Medicaid enrollment patterns is associated with state eligibility policies. Specifically, MACPAC examined the share of beneficiaries enrolled in 2018 who disenrolled and re-enrolled within a year (a phenomenon known as churn), and the share of beneficiaries continuously enrolled for 12 months. These enrollment statistics were compared to state adoption of 12-month continuous eligibility for children, mid-year data checks for changes in circumstances, and automated renewals using available information from other sources. The presentation concluded with a discussion of some limitations of this analysis and potential areas for future work.

After a break, staff presented on Medicaid programs in the five U.S. territories, and how they differ from states and one another, as well as information on their financing structure and spending trends. Medicaid in the territories operates on a capped allotment financing structure. Territories can only access federal funds up to an annual ceiling, and the federal medical assistance percentage (FMAP) for the territories is statutorily set at 55 percent (§ 1905(b) of the Act). The debate on funding extensions for the territories has once again raised the question of whether the territories should be treated more like states in both their financing structure (i.e., provide open-ended financing with an FMAP determined in the same way state FMAPs are determined) and certain programmatic requirements (e.g., providing all mandatory benefits and covering all mandatory populations). Although it appears that there will not be a major shortfall in Medicaid funds in the short term (as had been previously anticipated), staff raised several considerations for policymakers contemplating a permanent solution to financing challenges in the territories.

The day concluded with a staff presentation on Medicaid policy levers to address primary and specialty care workforce concerns. The presentation described how some state Medicaid programs have used opportunities within a Health Resources and Services Administration program for oral health providers to target the Medicaid workforce, state approaches using the Medicaid Delivery System Reform Initiative Payment demonstration waivers, and Medicaid graduate medical education to address workforce concerns.

On Friday, the day began with a staff presentation on monitoring access to care and services for Medicaid beneficiaries. Over the past decade, there have been several iterations of regulations for how states should monitor access to care and how managed care plans should assess adequate provider networks in the Medicaid program. MACPAC most recently published a chapter on monitoring access in the March 2017 report to Congress. This presentation provided background on the current monitoring systems in place, including Centers for Medicare & Medicaid Services (CMS) rules for monitoring access in fee for service and managed care, and challenges with the existing approach. It concluded with the Commission’s plan for the year.

Staff then provided an update on a congressionally mandated study on the Money Follows the Person (MFP) demonstration program, which has helped 44 states and the District of Columbia transition over 100,000 Medicaid beneficiaries from institutional settings back to the community. Community residences that MFP participants transition into must meet certain requirements, which differ from those in the home- and community-based services (HCBS) settings rule. Congress directed MACPAC to conduct a study to identify and report on differences in the settings that are available to MFP participants and the settings that qualify for HCBS payment under the settings rule. This presentation provided background on MFP and the HCBS settings rule, and described the work planned to complete this study.

Next, the Commission heard a panel discussion about the use of electronic health records (EHRs) among behavioral health providers, who have significantly lower rates of health information technology adoption compared to other providers within the health system. This can cause difficulties for integrating care for behavioral health patients, who have higher rates of premature mortality largely caused by chronic conditions. Jessica Kahn, a partner at McKinsey & Company; Bebet Herminio Navia, Jr., from the New Jersey Department of Human Services; and Brooke Hammond, director of Integral Care, a behavioral health provider in Austin, TX, discussed how greater EHR adoption could encourage better quality of care for behavioral health patients, and the challenges to adoption.

The meeting concluded with a presentation on Medicaid coverage of vaccines for adults. Children enrolled in Medicaid receive vaccines through the Vaccines for Children program; however, vaccines are considered an optional benefit for some adults, but are mandatory for others. In this presentation, staff provided background on Medicaid coverage of vaccines, barriers to vaccine access for adults enrolled in Medicaid, and findings from a new analysis of National Health Interview Survey data on adult vaccination rates. Finally, staff presented a policy framework for assessing federal policy options that could help improve vaccination coverage and access for Medicaid-enrolled adults.

Presentations