The Medicaid and CHIP Payment and Access Commission (MACPAC) released their March 2023 Report to Congress on Medicaid and CHIP. This report contains four chapters that cover recommendations for improving Medicaid race and ethnicity data collection, principles for assessing Medicaid nursing facility payment polices, strengthening evidence for Medicaid drug coverage, and an annual analysis of Medicaid Disproportionate Share Hospitals (DSH) allotments to states.
As required annually, the commission must make recommendations for updates to the Medicaid and CHIP programs. The commission releases reports each year in March and June that cover topics related to Medicaid and CHIP including payment, eligibility, enrollment and retention, coverage, access to care, quality of care, and the programs’ interaction with Medicare and the broader health care system.
To improve race and ethnicity data collection, MACPAC recommended updating the model application with updated questions to gather data along with including information on the purpose of each question, noting that the questions should be developed using evidence-based approaches for collecting complete and accurate data. Additionally, the commission recommended that the Centers for Medicare & Medicaid Services (CMS) develop training materials for workers assisting at the state and county levels to ensure applicants receive consistent information on the purpose of the race and ethnicity questions.
The report also provided recommendations around Medicaid nursing facility payment polices to address quality outcomes and transparency needs. To improve transparency, MACPAC recommended collecting facility level data on all types of Medicaid payments to nursing facilities, the sources of the nonfederal share of spending, and comprehensive data on nursing facility finances and ownership. Further, it recommended that the CMS update the requirement for states to conduct regular analyses of all Medicaid payments relative to the costs of care for Medicaid-covered nursing facility residents. The analysis should include an assessment of how payments relate to quality outcomes and health disparities.
To strengthen evidence under Medicaid drug coverage, MACPAC recommended that Congress allow states to exclude or restrict coverage of an outpatient drug based on coverage with evidence development requirements under a Medicare national coverage determination. They also recommended that Congress require managed care contracts to conform to state polices that exclude or restrict coverage of these outpatient drugs based on Medicare evidence development requirements.
Lastly, MACPAC provided their annual analysis of Medicaid DSH allotments to states. The report highlighted the impact the COVID-19 public health emergency had on hospitals, including a 0.03% decline in the uninsured from 2020 to 2021 and lower aggregate operating margins that were offset by DSH payments and provider relief funding. The commission estimated that in fiscal year 2024, DSH allotments would be reduced by 54% ($8 billion) beginning on Oct. 1 due to scheduled DSH payment reductions. The commission will continue to consider additional recommendations for inclusion in the June 2023 report to address countercyclical adjustments to DSH allotments.