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March 2017 Public Meeting

The March meeting opened with a panel on states’ approaches to treating opioid use disorders. Panelists included Kelly Murphy from the National Governors Association who provided an overview of NGA’s Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States. She was joined by Dr. Kate Neuhausen of the Virginia Department of Medical Assistance Services and Beth Tanzman of Vermont Blueprint for Health, who discussed how Medicaid in their states is promoting access to evidence-based treatment models for opioid use disorders.*

The Commission then turned to the issue of state flexibility, an often-discussed theme related to changes in financing. This session previewed a forthcoming MACPAC state policy compendium cataloguing state flexibility under Medicaid, including federal requirements and state options for determining Medicaid eligibility, enrollee cost sharing, and provider payment, among other policies. That session was followed by a review of the choices states have made in recent budget cycles to address fiscal pressures.

Later, staff briefed Commissioners on the congressionally requested study of mandatory and optional benefits and populations, scheduled for completion in the summer of 2017. The final session of the day continued the discussion begun in January on alternative approaches to Medicaid financing, focusing on parallels between per capita caps and current Medicaid policies for rate setting, and potential state-level effects of different per capita cap design elements.

On Friday, the Commission returned to prescription drug policy, with a panel on states’ experiences managing spending and use for high-cost drugs. Brian Bruen of The George Washington University’s Milken Institute School of Public Health presented MACPAC-commissioned work on state strategies for addressing the high cost of new specialized treatment for hepatitis C, followed by Susan Stuard of Oregon Health & Sciences University, who discussed how states are working within under current law to test innovative approaches for purchasing prescription drugs and managing spending

*MACPAC did not prepare a slide presentation for this session.


  1. State Flexibility Overview
  2. State Medicaid Responses to Fiscal Pressures
  3. Congressionally Requested Study on Mandatory/Optional Benefits and Populations: Review of Methods, Limitations, and Policy Issues
  4. Current Medicaid Parallels to Per Capita Financing Options
  5. Illustrations of State-Level Effects of Per Capita Cap Design Elements
  6. High-Cost Hepatitis C Drugs in Medicaid
  7. The Role of Section 1915(b) Waivers in Medicaid Managed Care