In this letter to U.S. Department of Health and Human Services Secretary Alex Azar, MACPAC expresses concern regarding a July 2019 rule proposed by the Centers for Medicare & Medicaid Services (CMS), rescinding the process states must use to document whether payments in fee-for-service (FFS) Medicaid are sufficient to meet Medicaid requirements for equal access to services under the Social Security Act.
MACPAC reiterates the importance of monitoring access in FFS, as more than half of Medicaid spending nationally is for services provided under that payment system. The populations who are most likely to receive services under FFS, such as individuals with disabilities, are among the most vulnerable; ensuring their access to services is particularly important given their high health needs. Furthermore, even in states with high managed care penetration, some services—such as long-term services and supports, dental services, and behavioral health services—may continue to be provided through FFS.
The Commission considers federal enforcement of the equal access provision to be the primary mechanism for ensuring that Medicaid beneficiaries have sufficient access to care and state activities to collect and report data are necessary for the federal government to carry out this obligation. While the Commission has long raised concerns about the administrative capacity constraints of state Medicaid programs, these constraints do not negate the federal obligation to ensure compliance with the equal access provision or the state obligation to provide adequate data to support such an assessment.
MACPAC acknowledges CMS’s stated commitment to develop more comprehensive and data-driven measures and methods, until improved methods are established it is the Commission’s view that existing requirements provide an ongoing and transparent monitoring approach for federal oversight.