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March 2021 Public Meeting

The March 2021 MACPAC meeting opened with staff presentations on policy options for behavioral health services for adults, youth, and children who are covered by Medicaid and the State Children’s Health Insurance Program (CHIP). Information from these presentations will be included in MACPAC’s June report to Congress.

At prior Commission meetings, MACPAC discussed the limited availability of behavioral health crisis services, which are critical in deescalating a mental health crisis, diverting individuals from the criminal justice system, and fostering more appropriate use of community-based services. Commissioners considered three policy options focused on how state Medicaid programs can help broader efforts to design and implement the three components of a crisis continuum: (1) a crisis hotline; (2) mobile crisis services; and (3) crisis stabilization centers.

The Commission then turned its attention to improving access to care for children and adolescents with behavioral health conditions. At prior meetings, MACPAC has discussed how many children and youth with behavioral health conditions enrolled in Medicaid and CHIP experience difficulty accessing treatment. The presentation included two policy options to help states design and implement home and community-based behavioral health services for those with significant mental health conditions. The Commission will vote on recommendations related to behavioral health services for adults, youth, and children who are covered by Medicaid and CHIP during its April public meeting.

After a break, Commissioners heard a presentation on how states can better manage the high costs of specialty drugs, focusing this meeting on one type: those approved through the U.S. Food and Drug Administration’s (FDA) accelerated approval pathway. This presentation built on the findings from MACPAC’s technical advisory panel presented in January and takes the next step toward a recommendation on changing payment policy for drugs receiving accelerated approval. The presentation provided the rationale and options for two recommendations to implement a differential rebate on accelerated approval drugs. The Commission will vote on the recommendations at its April meeting.

Next, the Commission heard a presentation on Medicaid policy issues related to the COVID-19 vaccine. The presentation summarized key findings from 11 stakeholder interviews that MACPAC conducted in early 2021, and described administrative and legislative action that will affect Medicaid coverage of the COVID-19 vaccine, including relief legislation currently being considered by Congress.

The Commission then heard a presentation that reviewed findings from an evaluation of the Center for Medicare & Medicaid Innovation’s Medicaid Innovation Accelerator Program (IAP), which was established in 2014 to provide technical assistance to help states implement Medicaid payment and delivery system reforms. Funding for the program expired in 2020. Overall, the evaluation found that states gained actionable knowledge from IAP but faced challenges when trying to implement new programs. The evaluation identified three common barriers to the successful implementation of IAP projects: state staffing challenges, changes in state priorities, and state budget constraints.

The day concluded with a panel discussion with officials from U.S. territories on issues facing their programs, including a major reduction in federal Medicaid funds (or fiscal cliff) that will occur in October 2021 without congressional intervention. Panelists included Helen Sablan, Medicaid administrator for the Commonwealth of the Northern Mariana Islands State Medicaid Agency; Jorge Galva Rodriguez, executive director of the Puerto Rico Health Insurance Administration (ASES); and Gary Smith, Medicaid director for the U.S. Virgin Islands Department of Human Services.


  1. Policy Options to Improve Access to Behavioral Health Services for Adults
  2. Policy Options to Improve Access to Behavioral Health Services for Children and Adolescents
  3. High-Cost Specialty Drugs: Moving Towards Recommendations
  4. Medicaid Policy Issues Related to the COVID-19 Vaccine
  5. Building State Capacity: What We Learned from the Medicaid Innovation Accelerator Program
  6. Panel Discussion: Current and Future Issues Facing the Territories