In the March 2017 Report to Congress on Medicaid and CHIP, MACPAC addresses three functions central to the roles of Medicaid and the State Children’s Health Insurance Program (CHIP) as the source of coverage for almost 90 million people:
- providing health insurance for children,
- making payments to safety-net hospitals, and
- monitoring access to care under managed care and fee for service (FFS).
Chapter 1 of the March 2017 report reprises the Commission’s January recommendations regarding the future of CHIP. CHIP provides comprehensive, affordable coverage for more than 8 million children who would otherwise be uninsured, either because their family incomes are too low to purchase private coverage but too high to qualify for Medicaid. However, the program’s funding is scheduled to expire in October 2017.
At the core of the nine-recommendation package is an extension of federal CHIP funding through FY 2022. This would ensure the stability and continuity of health insurance coverage for low- and moderate-income children at a time of tremendous uncertainty as Congress deliberates changes to health insurance markets. This recommendation would also mitigate budget uncertainty for states as they plan for the future.
Chapters 2 and 3 present the Commission’s statutorily required analyses of Medicaid disproportionate share hospital (DSH) payments, which help offset the uncompensated care costs of hospitals that serve a high proportion of low-income patients. In Chapter 2, new data on the Affordable Care Act’s effects on hospitals describe declining uncompensated care—particularly in states that expanded Medicaid to the new adult group—but also show the continued financial distress of many safety-net hospitals. Chapter 3 reviews various approaches to raising the minimum federal eligibility criteria for DSH payments in the effort to better target DSH payments.
The final chapter of the March report focuses on how states monitor Medicaid beneficiaries’ access to health care—an important set of tasks to ensure that Medicaid is achieving its mission. The chapter reviews what is known about access to care in Medicaid, describes measures and data that can be used to monitor access for different populations and geographic areas, and presents findings from MACPAC’s survey of state plan approaches to monitoring access. The chapter concludes with a discussion of key challenges to monitoring and evaluating access.
