January 2026 Public Meeting

MACPAC’s January 2026 meeting began with a discussion that continued the Commission’s examination of the use of managed care accountability tools. Managed care is the predominant delivery system in Medicaid. As such, the effective oversight of Medicaid managed care programs is a priority for stakeholders. MACPAC reviewed key findings from stakeholder interviews and analysis of the Managed Care Program Annual Reports available from the Centers for Medicare & Medicaid Services (CMS), identifying the opportunities and barriers to effective oversight that emerged from MACPAC’s study. Staff then presented policy options to address the opportunities to improve managed care organization accountability, with a focus on equalizing the authorities across fee-for-service Medicaid and managed care and on improving stakeholders’ ability to leverage available managed care plan data.

Next, the Commission continued its examination of appropriate access to residential treatment services for youth with behavioral health needs. MACPAC staff reviewed federal requirements for Medicaid coverage of residential treatment services, summarized key findings and challenges with access, and presented draft policy options that addressed key challenges. These draft policy options highlighted the absence of easily accessible, public information on facility and bed availability; the analysis of data on use of residential care, in particular in out-of-state facilities; and the need to strengthen discharge planning requirements, including for youth in out-of-state residential treatment.

Staff then presented considerations for implementing community engagement requirements in Medicaid.

For the first time, 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 introduced four principles for implementing community engagement requirements, which reflect findings from MACPAC’s stakeholder interviews and Commissioner discussions to date. Staff also presented a policy option for monitoring and evaluating community engagement requirements, based on our research and Commissioner interest. Commissioners discussed including the principles and policy option, in the form of a recommendation, in MACPAC’s June 2026 report to Congress.

After this, staff presented findings from MACPAC’s work demonstrating that Medicaid-covered children and youth with special health care needs can have challenges with the transition from child to adult Medicaid and may experience a gap or loss in coverage during this period. This session provided a summary of the interview and 2023 Transformed Medicaid Statistical Information System (T-MSIS) findings, key challenges, and current CMS requirements and guidance related to these challenges. MACPAC staff presented seven policy options for Commissioner consideration to address these findings.

The Commission then focused on home-and community-based services (HCBS) workforce shortages, which reduce Medicaid’s ability to serve people with long-term care needs in the home or community. Many states are exploring ways to use Medicaid rate setting to expand the HCBS workforce and reduce worker turnover. In previous MACPAC public meetings, staff discussed findings from a compendium of HCBS authorities, federal and state interviews, and a technical expert panel that explored strategies to ensure that HCBS payment rates are adequate to attract and retain a sufficient workforce. During this session, staff presented a draft chapter for the March 2026 Report to Congress and a recommendation to promote the HCBS workforce for a Commission vote. On Friday, the Commission voted in favor to approve the recommendation.

Next, staff presented draft chapters for the March 2026 Report to Congress. A chapter on behavioral health in Medicaid and the State Children’s Health Insurance Program included findings from the Commission’s analytic work using calendar year 2023 T-MSIS data to measure utilization and spending for Medicaid and Medicaid expansion State Children’s Health Insurance Program (M-CHIP) enrollees with behavioral health conditions and intellectual or developmental disabilities. Another draft chapter examined Medicaid for justice-involved youth. It described findings from the Commission’s work on selected state efforts to implement requirements that seek to improve care transitions for justice-involved youth who return to the community.

After Friday’s vote to approve a recommendation related to promoting the HCBS workforce, staff presented findings from a literature review, a federal policy review, and stakeholder interviews on the role of automation in the Medicaid prior authorization process. During this session, MACPAC summarized the findings from this project, including how states and managed care organizations (MCOs) use automation in prior authorization; the extent of federal and state oversight, guidance, and regulation of automation in prior authorization; potential risks posed by automation in prior authorization; and the impact of the existing regulatory environment on states’ and MCOs’ adoption of automation.

Next, the Commission heard a presentation on new work examining how state Medicaid agencies oversee the Program for All-Inclusive Care for the Elderly (PACE) organizations and carry out their oversight responsibilities. PACE is a provider-led model that offers fully integrated care to frail adults ages 55 and older with nursing-facility level of care needs while allowing them to remain in the community. The presentation highlighted findings from a review of three core oversight documents: required three-way program agreements among the CMS, states, and PACE organizations; optional two-way agreements between states and PACE organizations; and waiver requests submitted under Section 903 of the Medicare, Medicaid, and the SCHIP Benefits Improvement and Protection Act of 2000 (BIPA, P.L. 106-554), known as BIPA 903 waivers.

To end the meeting, staff presented a federal policy scan of health and welfare assurances in HCBS. Self-direction is a beneficiary-controlled HCBS delivery model. CMS requires that states provide satisfactory assurances of certain protections for HCBS beneficiaries, including those enrolled in self-directed HCBS programs. These protections include assurances related to the health and welfare of enrollees. Findings focused on incident management systems, conflict of interest standards, and safeguards specific to self-direction. Commissioners discussed these findings and provided feedback on areas for further investigation.

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