The Medicaid and CHIP Payment and Access Commission (MACPAC) is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide array of issues affecting Medicaid and the State Children’s Health Insurance Program (CHIP). This article focuses on three MACPAC recommendation areas that are most pertinent for LeadingAge members: access to high quality services, state integrated care strategies for people who are dually eligible and advancing health equity.

MACPAC calls for a New Medicaid Access Monitoring System

A key measure of the effectiveness of any health coverage program, especially a safety net program like Medicaid, is whether it provides timely access to high-quality services. Ensuring access to needed services is incredibly important, and both federal and state governments have a statutory obligation to ensure access. In the Commission’s view, CMS should establish a new regulatory structure to monitor access and address inadequacies with three key domains of access:

• provider availability and accessibility,
• service use, and
• beneficiary perceptions and experiences of care

The current approach to monitoring access does not measure key domains of access or provide comparable or actionable data, which are needed for policymakers and stakeholders to assess whether the Medicaid program is meeting this obligation. The Commission recommends that CMS develop an ongoing and robust access monitoring system consisting of a core set of measures for a broad range of services that are comparable across states and delivery systems. MACPAC encourages CMS to pay particular attention to creating consistent definitions and methods to identify HCBS providers, given the state variation in codes used for this type of provider claim. For example, CMS could assess the quality of the HCBS data and assist states in improving collection and reporting on these measures.

The Commission also recommends that a new monitoring approach include an annual federal Medicaid beneficiary survey to collect information on beneficiary perceptions and experiences with care. In addition, MACPAC suggests that CMS should further standardize and improve the Transformed Medicaid Statistical Information System (T-MSIS) data to allow for meaningful cross-state comparisons and provide technical assistance to states to collect and analyze.

The report also calls for making integrated care a standard for people who are dually eligible for Medicaid and Medicare

There are 12.2 million people who are dually eligible for Medicaid and Medicare. While integrating care for beneficiaries of these programs has the potential to improve care and reduce federal and state spending, only about 1 million full-benefit dually eligible beneficiaries were enrolled in integrated care models in 2020.

Some states are further along than others in integrating care for these beneficiaries. To raise the bar on integration, the Commission recommends requiring all states to develop an integrated care strategy within two years. These state strategies should address how the state will approach integration, eligibility, and benefits covered, enrollment strategy, beneficiary protections, data analytics, and quality measurement—and be structured to promote health equity. Given the level of effort and specialized expertise needed to integrate care, MACPAC also recommends that Congress provide additional federal funding to support states in developing their strategies.

It’s important to note that on May 19, the Senate Special Committee on Aging held a hearing focused on senior mental health and integrated care. During the hearing, Senator Casey and Senator Scott introduced the Advancing Integration in Medicare and Medicaid Act (AIM Act), which is a bipartisan bill to require states to develop a strategy for integrating and coordinating health benefits for full-benefit dually eligible beneficiaries. Senator Casey also introduced the Supporting States in Integrating Medicare and Medicaid Act, which is similar in scope to the bipartisan bill, but additionally provides funding support for states.

MACPAC’s call for advancing health equity in Medicaid

MACPAC commits to deepening its work on health equity and continuing to use a health equity lens throughout its work. Health disparities have long existed for Medicaid beneficiaries of color, and MACPAC identifies key areas in which Medicaid policy can advance health equity, including collection and reporting of race and ethnicity data; the role of state leadership in prioritizing a health equity agenda; beneficiary engagement in the policymaking process; and development of a diverse and culturally competent workforce.

MACPAC highlights its concern about the potential for disruption in Medicaid coverage and care for beneficiaries of color when the PHE eventually ends, given the unprecedented volume of redeterminations that will occur. MACPAC notes that it will be important for CMS and states to work with trusted community-based organizations and to support Medicaid beneficiaries with limited English proficiency.