June 2021 Report to Congress on Medicaid and CHIP

MACPAC’s June 2021 Report to Congress on Medicaid and CHIP addresses these issues: high-cost specialty drugs in the Medicaid program; access to mental health services for those enrolled in Medicaid and the State Children’s Health Insurance Program (CHIP) integration of physical and behavioral health care through electronic health records (EHRs); Medicaid’s non-emergency transportation (NEMT) benefit; and state strategies for integrating care for people who are dually eligible for Medicaid and Medicare.

Chapter 1 addresses high-cost specialty drugs, which are increasingly driving Medicaid spending and creating financial pressure for states. The Commission recommends that Congress increase the minimum rebate percentage on drugs approved by the U.S. Food and Drug Administration (FDA) through the accelerated approval pathway until the manufacturer has verified the clinical benefit. The Commission also recommends an increase in the additional inflationary rebate on drugs that receive approval from the FDA through the accelerated approval pathway. Once the FDA grants traditional approval, the Medicaid rebates would revert back to the standard amounts.
Chapter 2 focuses on the needs of adults with mental health conditions and the role of Medicaid in supporting crisis services. Medicaid beneficiaries with mental illness often have unmet needs and difficulty getting appropriate services. The Commission recommends that the Secretary of the U.S. Department of Health and Human Services (the Secretary) direct relevant agencies to issue guidance that addresses how Medicaid and CHIP can be used to fund a crisis continuum for beneficiaries experiencing behavioral health crises. The second recommendation calls on the Secretary to direct a coordinated effort to provide education, technical assistance, and planning support to expand access to such services.
Chapter 3 makes recommendations to address the unmet behavioral health needs of children enrolled in Medicaid and CHIP and avoid out-of-home placements. The Commission recommends that the Secretary direct relevant agencies to issue joint subregulatory guidance that addresses the design and implementation of benefits for children and adolescents with significant mental health conditions covered by Medicaid and CHIP. The second recommendation calls on the Secretary to direct a coordinated effort to provide education, technical assistance, and planning support to expand access to such services.
Chapter 4 looks at how EHRs can be used to strengthen clinical integration and improve patient care. EHR adoption remains low among behavioral health providers. The chapter discusses barriers to EHR adoption and concludes by identifying ways to strengthen EHR uptake among Medicaid’s behavioral health providers.
Chapter 5 fulfills a congressionally mandated report on Medicaid’s NEMT benefit. Federal law requires that state Medicaid programs ensure transportation to and from providers. While the share of Medicaid beneficiaries who use NEMT is relatively small, NEMT plays a vital role in facilitating access to care for those who rely on it.
Chapter 6 continues the Commission’s work focusing on integrating care for individuals who are dually eligible for Medicaid and Medicare. We explore ways that states can use existing contracting authority to better integrate care through Medicare Advantage dual eligible special needs plans (D-SNPs). The chapter describes why MACPAC is focused on D-SNPs, contracting strategies available to states, the ability of states to use these strategies, and MACPAC’s plans for future work on federal policy that could give further momentum to state efforts.

Chapters: