In a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure, MACPAC commented on a CMS proposed rule on technical changes to Medicare Advantage (MA) for contract year 2026.
The proposed rule would make mandatory coverage of certain weight loss drugs for obesity through Medicaid, for which states will need to develop coverage criteria, and may create the risk that costs could temporarily shift from Medicare to Medicaid for dually eligible individuals, MACPAC wrote. It would also make a number of changes affecting dually eligible beneficiaries and establish new integration requirements for applicable integrated plans. It would codify CMS timelines for MA special needs plans to conduct health risk assessments and develop individualized care plans, as well as make changes intended to improve awareness and transparency of cost-sharing tools.
It has long been the Commission’s view that integrated care has the potential to improve care for dually eligible beneficiaries, eliminate incentives for cost shifting between Medicare and Medicaid, and reduce spending that may arise from duplication of services or poor care coordination. MACPAC’s comments in this letter draw on the Commission’s prior work and highlight relevant MACPAC recommendations that CMS may choose to consider as it moves to finalize the proposed rule.
