April 2026 Public Meeting

The April 2026 MACPAC meeting began with a staff presentation on a draft chapter for the June 2026 report to Congress describing findings from the Commission’s analytic work on considerations for implementing community engagement requirements in Medicaid. The draft chapter begins with background on community engagement requirements in Medicaid and an overview of the statutory requirement in the 2025 Budget Reconciliation Act (P.L. 119-21). Then, it outlines the Commission’s principles and corresponding considerations for implementing community engagement requirements as supported by the research. The chapter concludes with a discussion of the Commission’s potential recommendation for monitoring and evaluation.

Next, the Commission focused on the effective oversight of Medicaid managed care programs. Staff reviewed key findings from the draft chapter for the June 2026 report to Congress, identifying the opportunities and barriers to effective oversight that emerged from MACPAC’s study. Staff presented policy recommendations to address the opportunities to improve managed care plan accountability. The recommendations seek to improve the usability of managed care performance data and provide states with additional guidance and tools to more effectively assess and oversee plan performance. On Friday, the Commission voted in favor of the recommendations.

MACPAC staff then presented a draft chapter for the June 2026 report to Congress and six recommendations to improve coverage transitions for children and youth with special health care needs (CYSHCN). The chapter begins with background on the Medicaid-covered CYSHCN population and their transitions from child to adult Medicaid coverage and the federal requirements for Medicaid redeterminations and transitions between Section 1915(c) home- and community-based services (HCBS) waivers. The chapter includes findings on the state role in facilitating the transition to adult Medicaid coverage and key challenges beneficiaries experience with the process. Finally, the chapter presents the six recommendations, the rationale for the recommendations, and implications for federal spending, states, enrollees, plans, and providers.

After a break, staff presented findings on automation in the prior authorization (PA) process. MACPAC conducted a literature review, a federal policy review, and stakeholder interviews on the role of automation in the Medicaid PA process. Staff previously presented on the findings and challenges surfaced in this research, including the availability of information and documentation about the implementation and use of automation and the current state and federal policy landscape specific to automation in PA. MACPAC presented draft policy recommendation language for Commission consideration.

The Commission then considered recommendations about the Program of All-Inclusive Care for the Elderly (PACE) model, which provides integrated care to adults ages 55 and older who meet nursing facility level-of-care criteria and can live safely in the community. Findings from the June 2025 report to Congress identified questions related to transparency in state and federal oversight of PACE compliance and quality. At the January 2026 Commission meeting, staff presented findings from a review of key federal and state oversight documents, including program agreements and related materials. At the March 2026 meeting, staff presented findings from interviews with state Medicaid officials, Centers for Medicare & Medicaid Services (CMS) staff, and PACE experts. In this session, staff presented policy options to the Commission that address two challenges identified during the document review and stakeholder interviews: (1) overlap and lack of coordination in federal and state audit activities, and (2) the limited availability of information on PACE program quality and performance.

After this, MACPAC staff presented an environmental scan of three states to better understand the strategies states employ to ensure beneficiary health and welfare in self-direction and how those strategies compare to or align with existing federal policy. Staff found that all states have policies and procedures in place to protect beneficiary health and welfare in self-direction, often employing safeguards beyond what is required in federal statute and regulation. These safeguards include policies on incident management and reporting, monitoring service delivery and expenditures for risk detection, representatives, mandatory disenrollment and continuity of care, HCBS provider standards, and program integrity and quality oversight.

To conclude the day, staff presented background information from an upcoming issue brief describing pharmacy benefit managers (PBMs) and their role within Medicaid. PBMs have a central role in the drug distribution chain and serve as intermediaries in administering the prescription drug benefit on behalf of payers. In recent years, some policymakers and stakeholder groups have identified the role of PBMs in the Medicaid drug distribution chain as a potential driver of increased drug spending.

After a vote to approve recommendations related to Medicaid managed care accountability, MACPAC staff presented results from a literature review and federal policy review on Medicaid program integrity. Staff shared findings from this research and introduced program integrity topics to be explored during the next phase of project work exploring the role of the federal government in supporting state program integrity efforts.

The Commission then heard a staff presentation on findings from a policy scan and literature review on Medicaid coverage of assistive technology (AT) for adults. MACPAC is exploring Medicaid coverage of AT for adults using HCBS. AT in Medicaid refers to a wide range of items that help beneficiaries maintain or improve their functional capabilities. HCBS programs are the primary source of Medicaid coverage of AT for adults. MACPAC is identifying the statutory and regulatory framework that governs how states cover AT and assessing whether there are barriers to coverage of and access to AT that federal Medicaid policy could address.

To conclude the meeting, the Commission continued its examination of behavioral health services for Medicaid-enrolled children and youth with behavioral and co-occurring health needs. The first phase of work examined appropriate access to residential treatment services for children and youth who require this level of treatment and resulted in a chapter in MACPAC’s June 2025 report to Congress. This second phase focuses on access to intensive community-based behavioral health services that prevent the inappropriate use of residential treatment for children and youth who are at risk of needing this type of treatment. Given the broad scope of services, this work focuses on five specific services that have been shown to be particularly important for this population: intensive care coordination or targeted case management; high-fidelity wraparound, mobile crisis response; crisis stabilization; and respite.

MACPAC staff presented background on this population, a summary of key federal requirements to ensure access to behavioral health services, and an overview of intensive community-based behavioral health services. Staff then reviewed key findings from our federal and state policy scans, describing relevant state plan and waiver authorities that states use to deliver the five selected services.

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