March 2021 Report to Congress on Medicaid and CHIP

MACPAC’s March 2021 Report to Congress on Medicaid and CHIP contains five chapters and offers Congress a number of timely recommendations related to 1) improving Medicaid’s responsiveness during economic downturns; (2) addressing concerns about high rates of maternal morbidity and mortality; (3) reexamining Medicaid’s estate recovery policies; (4) integrating care for people who are dually eligible for Medicaid and Medicare; and (5) improving hospital payment policy for the nation’s safety-net hospitals.

Chapter 1 addresses the challenge that states face during recessions when Medicaid enrollment grows and state revenues decline. It contains a recommendation for an automatic countercyclical Medicaid financing adjustment that would ensure that additional federal funds flow quickly to Medicaid during economic downturns, giving states greater budget predictability.
Chapter 2 focuses on the importance of postpartum care in the year after delivery and the unacceptably high rates of maternal mortality and morbidity among people of color generally and among those covered by Medicaid specifically. The chapter contains recommendations to expand postpartum coverage under Medicaid and CHIP, making it mandatory for states to extend postpartum coverage from 60 days to a full year with 100 percent federal matching rate.
Chapter 3 examines the burden of Medicaid estate recovery, which often falls on those with modest means, and may disproportionally affect people of color and perpetuate intergenerational poverty. The chapter contains three recommendations related to easing the burden of estate recovery, including making estate recovery optional, rather than mandatory, as was allowed under prior law.
Chapter 4 continues the Commission’s work integrating care for individuals who are dually eligible for Medicaid and Medicare. The chapter examines key design issues that would need to be addressed to establish a unified program for those now covered by two separate programs.
Chapter 5 chapter contains MACPAC’s annual report on Medicaid disproportionate share hospital (DSH) allotments to states. As in prior years, the Commission continues to find little meaningful relationship between state DSH allotments and the number of uninsured individuals; the amounts and sources of hospitals’ uncompensated care costs; and the number of hospitals with high levels of uncompensated care that also provide essential community services for low-income, uninsured and vulnerable populations.

Chapters: