MACPAC’s December 2025 meeting began with a discussion on children and youth with special health care needs (CYSHCN) and their transition from child to adult Medicaid eligibility. This work focused on how this transition may overlap with other age-related transitions, including the age-18 Supplemental Security Income redetermination and the transition between child-only and adult Section 1915(c) home- and community-based services (HCBS) waivers.
Staff presented on findings from an analysis of the Transformed Medicaid Statistical Information System (T-MSIS) and stakeholder interviews. Staff shared findings from an analysis of coverage transitions and gaps in enrollment during the transition from child to adult Medicaid using T-MSIS. This session also highlighted factors that affect the Medicaid redetermination and 1915(c) HCBS waiver transition processes and identified key challenges and policy considerations for state Medicaid agencies.
Next, MACPAC staff presented findings from interviews with states and other stakeholders on implementing the community engagement requirement in Medicaid. States will soon be required to make Medicaid eligibility for certain applicants and existing beneficiaries contingent on their participation in qualifying community engagement activities in accordance with Public Law 119-21, an Act to Provide for Reconciliation Pursuant to Title II of H. Con. Res. 14 (2025 Budget Reconciliation Act). This session revisited the details of the new community engagement requirement and highlighted key implementation considerations for states and the Centers for Medicare & Medicaid Services (CMS) based on stakeholder interviews.
The considerations generally focus on state processes for determining compliance and exceptions, including key questions related to Medicaid information technology systems and data availability. States and other stakeholders also highlighted areas where states would benefit from timely federal guidance, technical assistance, and other support. The Commission is interested in plans to monitor community engagement requirement implementation and will have further discussion of that topic at MACPAC’s January public meeting.
The Commission then heard from an expert panel about implementation considerations and areas where states would benefit from timely federal guidance and technical assistance. The panel also focused on CMS’s approach to supporting state implementation and lessons from the public health emergency unwinding that can inform CMS and state efforts.
Panelists included:
- Lindsey Browning, Deputy Executive Director of Programs, National Association of Medicaid Directors
- Caprice Knapp, Principal Deputy Director, Center for Medicaid and CHIP Services, Centers for Medicare & Medicaid Services
MACPAC’s December meeting concluded with a discussion about state and federal tools for ensuring accountability in Medicaid managed care. Managed care is the predominant delivery system in Medicaid. As such, oversight of Medicaid managed care programs is a priority. This session continues our work on the use of managed care accountability tools. It provided the background and federal requirements for oversight and then described themes from stakeholder interviews across three key areas: procurement and contract requirements, use of accountability tools, and CMS oversight and guidance. Additionally, staff supplemented the interview findings with an analysis of Managed Care Program Annual Reports, which are available through CMS.
Presentations
- Children and Youth with Special Health Care Needs (CYSHCN) Transitions to Adult Coverage: T-MSIS & Interview Findings
- Considerations for Implementing Community Engagement Requirements: Findings from Stakeholder Interviews
- State and Federal Tools for Ensuring Accountability of Medicaid Managed Care Organizations: Interview Findings