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December MACPAC Meeting

• The Medicaid and CHIP Payment and Access Commission (MACPAC) met on December 14-15 to discuss topics including: Medicaid sexual orientation and gender identity data collection, barriers to improving transparency of Medicaid financing, analysis of Medicaid DSH allotments to states, engaging beneficiaries through Medical Care Advisory Committees (MCACs) to inform Medicaid policymaking, data update on unwinding the continuous coverage provision, potential areas for comment on the CMS proposed rule on Medicare Advantage for 2025, highlights from MACStats 2023, Medicare-Medicaid plan (MMP) transition monitoring, and the future of integrated care for dually eligible beneficiaries (MACPAC, December 14-15).
  • MACPAC is focused on assessing and addressing health disparities through the collection of data regarding primary language and limited English proficiency (LEP), sexual orientation and gender identity (SOGI), and disability. The Commission reviewed the purpose of SOGI data and the federal and state priorities for collecting this information, including an overview of the new guidance from CMS regarding SOGI data on Medicaid applications. The Commission also reviewed how this information is currently collected and data privacy considerations (MACPAC, December 14).
  • MACPAC reviewed themes from expert interviews about the challenges in improving the transparency of Medicaid financing. The presentation reviewed previous work on Medicaid financing. Barriers to transparency included unclear goals of additional transparency requirements; incomplete information about state-level methods and amounts; multiple approaches to collect provider-level financing amounts; and challenges to using these amounts to calculate net payments (MACPAC, December 14).
  • MACPAC presented that disproportionate share hospital (DSH) payments have no significant relationship with the measures of need that Congress tasked the Commission with considering. These include the changes in the number of uninsured individuals, amounts and sources of uncompensated care, and hospitals with high levels of uncompensated care that also provide access to essential community services. MACPAC estimates that FY 2024 DSH allotments will be reduced by 51%, or $8 billion, on January 20, 2024, due to the scheduled reductions outlined in the Further Continuing Appropriations and Other Extensions Act, 2024 (MACPAC, December 14).
  • The Commission continued its discussion on the role of MCACs in supporting state Medicaid agencies’ policymaking efforts and including beneficiaries’ voices in program structure. The MACPAC staff presented a draft chapter for the March 2024 report to Congress with three recommendations on how states can improve beneficiary experience and how the federal government can support these efforts. The first recommendation was to have CMS issue guidance related to concerns of beneficiary recruitment challenges, strategies to facilitate beneficiary engagement, and to clarify financial arrangements to best facilitate engagement with the MCAC. The second recommendation was that state Medicaid agencies should include provision in their bylaws that promote diverse beneficiary recruitment. The final recommendation was that state Medicaid agencies should develop and implement a plan to streamline the application process and reduce the requirements needed to apply. The Commission voted in favor of the recommendations (MACPAC, December 14).
  • This presentation provided an update of the unwinding of the continuous coverage process to the Commission. It included the most recent data available from CMS on renewal outcomes, changes in enrollment, and operational outcomes. As of August 2023, 50% of all redeterminations conducted have resulted in a renewal of coverage. 7.5 million have had their coverage terminated, 73% of which were terminated for procedural reasons. From March to July 2023 overall enrollment in Medicaid decreased, though 12 states experienced increases in enrollment. Regarding transitions of coverage from Medicaid to the Marketplace, state exchanges had higher percentages of people selecting a plan compared to the Federal exchange, 12% compared to 8%. For operations, call center volume increased in all but three states. And average wait time and call abandonment rates varied widely across states. Finally, there was an overall increase in Medicaid and CHIP applications submitted in July 2023, though 12 states experienced a decline in applications. 70% of MAGI applications were processed within seven days across 48 states that report this data (MACPAC, December 14).
  • The Commission discussed the CMS proposed rule that would make technical changes to Medicare Advantage and Medicare Part D for 2025. This includes dual eligible special needs plans (D-SNPs). The presentation summarized the proposed provisions that affect dual eligible beneficiaries and that overlap with the Commission’s current work. The Commission plans to discuss further and comment on the proposed rule (MACPAC, December 14).
  • MACPAC shared their annual highlights from the MACStats: Medicaid and CHIP Data Book, which complies the most current data on the programs into a single, end-of-year publication. The publication includes data and statistics on enrollment, spending, and key aspects of the programs, including federal match rates, access to care, and eligibility levels across the country (MACPAC, December 14).
  • MACPAC staff discussed the transition monitoring framework that was put in place after the May 2022 final rule that sunsets MMPs, encouraging all states with MMPs to transition beneficiaries to integrated D-SNPs. The final rule contained changes to increase D-SNP integration by including specific elements of MMPs. The transition monitoring framework includes stakeholder engagement, procurement activities, system changes, and enrollment processes. MACPAC staff reviewed the stakeholder engagement that has been completed through existing strategies such as advisory committees and the ombudsman program, and enhanced strategies including listening session, focus groups, and virtual outreach. The next step is procurement activities for most MMP states, but during this process, states are likely to stop stakeholder engagement processes (MACPAC, December 15).
  • MACPAC invited three panelists to participate in a discussion about the MMP transition, state considerations for those developing integrated D-SNPs, and the future of integrated care for dually eligible beneficiaries, offering MACPAC commissioners the opportunity to engage in a larger conversation. Panelists included: Tim Engelhardt, Director, Medicare-Medicaid Coordination Office, CMS; Michael Monson, CEO and President, Altarum; and Michelle Herman Soper, VP of Public Policy, Commonwealth Care Alliance (MACPAC, December 15).

CMS Announces Funding Opportunity for Maternal Health Initiatives

• On December 15, CMS announced they will offer up to $17 million in funding over 10 years for up to 15 states to test Medicaid initiatives designed to address the maternal health crisis through the Transforming Maternal Health program. The program is intended to provide a holistic approach to childbirth and postpartum care that addresses patients’ physical, mental, and social needs. CMS hopes that the funding offered to states through the program will encourage them to improve care from the pre-natal  through the postpartum period by facilitating or improving access to midwives, doulas, and social workers and by licensing birthing centers, particularly in rural and low-income areas (Modern Healthcare, December 15; Inside Health Policy, December 15).

SPAs

• Kansas Governor, Laura Kelly, has introduced a bill designed to convince state lawmakers to back Medicaid expansion. Governor Kelly believes that the plan is “revenue neutral” and will expand coverage to 150,000 additional Kansans who currently make too much money to qualify for the program without costing the state more money. Governor Kelly’s plan would include work requirements and seeks to cut healthcare costs, create jobs, and grow the economy at no additional cost for taxpayers. With expansion, the federal government would cover 90% of the costs with the remaining 10% coming from the state budget and completely covered by drug rebates, a hospital fee, savings from higher reimbursement rates for existing Medicaid recipients, and additional federal funding (Health Payer Specialist, December 18).
• Rhode Island is restarting its Medicaid managed care bidding process after scrapping its initial effort earlier this year in May. Blue Cross Blue Shield of Rhode Island and Tufts Health Plan, now rebranded as Point32Health following a merger with Harvard Pilgrim Health Care, had issues with the submission of their bids. Molina, United, Neighborhood Health Plan of Rhode Island, and Commonwealth Care Alliance submitted bids without issue. The new bids are due on February 23, 2024, and contracts will start on July 1, 2025. The new contracts will be for five years with the possibility of an annual extension for up to five years following the end date of the original contract. The current contract holders, Tufts, UnitedHealth, and Neighborhood Health have agreed to an extension of services until June 30, 2025 (Health Payer Specialist, December 18).