In the March 2018 Report to Congress on Medicaid and CHIP, MACPAC addresses managed care, telehealth, and disproportionate share hospital (DSH) payment—three aspects of Medicaid that are of high interest to Congress as it considers opportunities to improve efficiency and impact of this program that provides critical health services to over 80 million people.
Medicaid has evolved from a primarily fee-for-service delivery system to one in which 80 percent of beneficiaries receive their health care through managed care. In Chapter 1, the Commission offers Congress three recommendations to streamline the statutory authorities that enable states to adopt managed care without reducing beneficiary protections.
Telehealth—the use of interactive telecommunication to deliver health services—has the potential to improve access to providers and services for underserved populations. Chapter 2 describes how states cover telehealth in Medicaid and discusses its use in three areas of particular importance in Medicaid: oral health, behavioral health, maternity care, and high-cost, high-need populations.
In Chapter 3, MACPAC fulfills its annual, statutorily mandated obligation to report on DSH allotments. As in previous years, the Commission finds no meaningful relationship between states’ DSH allotments and the factors Congress required the Commission to examine. We also find that total hospital charity care and bad debt continues to fall since the implementation of the Patient Protection and Affordable Care Act.