This presentation reviews a draft chapter on streamlining Medicaid managed care authorities planned for the March 2018 Report to Congress on Medicaid and CHIP.
States’ use of managed care to administer Medicaid has increased substantially over the years. Historically, states have administered Medicaid managed care under three separate authorities—Section 1115, Section 1915(b), and Section 1932 of the Social Security Act—that have served different programmatic purposes. However, managed care regulation and oversight is now standardized across these three authorities.
MACPAC’s inquiry was motivated by an interest in how to reduce the administrative burden associated with 1915(b) waivers while continuing to ensure adequate beneficiary protections. The Commission considered three draft recommendations to Congress: (1) allowing states to require all beneficiaries to enroll in comprehensive Medicaid managed care programs under state plan authority; (2) extending the approval and renewal periods for Section 1915(b) waivers from two to five years; and (3) revising Section 1915(c) waiver authority to waive freedom of choice and selective contracting.
The Commission unanimously approved the latter two recommendations, which would have the effect of consolidating 1915 (b) and (c) waiver authorities, but reserved the first recommendation on state plan authority for further discussion at the January 2018 meeting.