MACPAC’s June Report to Congress: Do More on Payment Transparency and Duals Coordination

MACPAC's June Report to Congress: Do More on Payment Transparency and Duals Coordination

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The Medicaid and CHIP Payment Access Commission (MACPAC) serves as a non-partisan advisory and analytic agency to Congress and members of the presidential administration. Each year, the commission is statutorily required to submit reports to congress in March and June. The June 2024 report is split into four sections. The sections of this report include:

1. Improving the Transparency of Medicaid and CHIP Financing
2. Optimizing State Medicaid Agency Contracts
3. Medicare Savings Program: Enrollment Trends
4. Medicaid Demographic Data Collection

Commissioners have spent extensive time analyzing Medicaid and CHIP financing in search of information on full provider reimbursements. This includes understanding state-level use of non-federal shares of Medicaid funding. States use a plethora of financing mechanisms to build out non-federal shares of Medicaid financing such as provider taxes, legislative access add-ons, intergovernmental transfers, among others. These mechanisms allow states to use funds other than taxpayer dollars in the general fund to garner federal match in Medicaid programs.

Total funds (including federal matching funds) are then distributed to providers through base rates, supplemental quality payments, or access payments, to name a few. Because of the breadth of options and differences in programs across states, it is very difficult to understand fully what each provider is being paid for services rendered. Because of these complicated financing schemes, all reasonably allowable in law and regulation, it becomes difficult to analyze if providers are receiving enough (or too much) funding to further Medicaid's goals of efficiency, economy, quality, and access.

The second section focusses on ways states can improve contracts with Dual-Eligible Special Needs Plans (D-SNPs) to promote coordination of care and benefits between Medicare and Medicaid. Improved coordination of benefits and the ability access available benefits improves health outcomes over the long-term and reduces total healthcare spending by preventing more costly future treatments. The Commission recommends that congress mandate state submission of data for dually eligible individuals enrolled in D-SNPs on encounters and care coordination. The reporting should further outline how the data is used to further the state's goals for improving care delivery for dual eligibles.

The third section focused on Medicare Savings Program (MSPs) enrollment trends. MACPAC reviewed data on utilization of MSPs from 2010 and found low participation in the program. Following recommendations to and implementation by the Centers for Medicare and Medicaid Services (CMS) that streamlined MSP enrollment MACPA revisited their prior analysis. It was determined that efforts to increase awareness of MSPs for dual eligibles has been successful with 80% of duals enrolled in an MSP in 2021. More evaluation is pending to determine if enrollment trends demonstrate access disparities for certain populations.

The final section assessed Medicaid demographic data collection and the ongoing need for states to update Medicaid applications and renewals to collect information on race, ethnicity, primary language, sexual orientation and gender identity, and disability to promote data analysis of Medicaid programs' abilities to overcome disparities in access for historically marginalized populations. MACPAC noted that consideration should be given the burden on applicants in filling out additional administrative data, while balancing the need for state to obtain this information to analyze possible biases and disparities inherent to states' systems.

The report contains abundant and valuable information in each chapter and can serve as a resource for individuals seeking to educate themselves on state-level alternative payment models, how states leverage contracts with Medicare Advantage D-SNPs, and how data can be used to overcome disparities in program administration.