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October 2021 Public Meeting

The October 2021 MACPAC meeting opened with a brief presentation and panel discussion on the data available to monitor access to care for Medicaid beneficiaries across three domains–provider availability and accessibility, beneficiary use of services, and beneficiary perceptions and experiences. This session provided an overview of existing data, gaps in data, and possible approaches to address those gaps based on findings from a literature review and key stakeholder interviews. The Commission heard from Dr. Genevieve Kenney, co-director and senior fellow in the Health Policy Center at the Urban Institute; Dr. Joseph Caldwell, director of the Community Living Policy Center at Brandeis University; and Barry Cambron, deputy commissioner for health systems at the Alabama Medicaid Agency.

Later, staff presented the results of an analysis for a congressionally mandated study on the Money Follows the Person (MFP) demonstration, first authorized by the Deficit Reduction Act of 2005 (DRA, P.L. 109-171). MFP funds may be used to transition beneficiaries into specific settings defined in the DRA, a much more limited definition than permitted for Medicaid home-and community-based services (HCBS) more generally. Congress directed MACPAC to identify settings available to MFP participants and settings that qualify for HCBS payment under the settings rule. If deemed appropriate, the Commission could recommend policies to align MFP residence criteria with the HCBS settings rule. This presentation provided the results of MACPAC’s analysis to date, which include data on transitions, a survey of MFP program directors, and stakeholder interviews. While the survey demonstrated support among program directors for changing the criteria, viewpoints among other stakeholders were mixed. The presentation closed with a discussion of the policy options the Commission can consider as it deliberates whether to make recommendations in the mandated report.

Next, the Commission turned its attention to vaccine coverage and access for adults enrolled in Medicaid. In September 2021, staff shared findings from an analysis of National Health Interview Survey data estimating adult vaccination rates. In this presentation, staff presented key findings from stakeholder interviews with state and federal officials, Medicaid managed care plans, providers, vaccine manufacturers, immunization experts, and a consumer group. Staff also presented an initial assessment of several policy options based on the findings from stakeholder interviews.

The day concluded with a staff presentation on MACPAC’s statutorily required annual report on Medicaid disproportionate share hospital (DSH) allotments, which will be included in the March report to Congress. The Commission heard updated analyses of the data elements that MACPAC is statutorily required to report. This presentation also provided updates on the uninsured rate during the COVID-19 pandemic, DSH allotment changes during the public health emergency, and the treatment of third-party payments in the calculation of Medicaid shortfall.

On Friday, the day began with discussion on state efforts to integrate care for people who are dually eligible for Medicaid and Medicare. About 3 million dually eligible beneficiaries are enrolled in Medicare Advantage dual eligible special needs plans (D-SNPs), which are present in 43 states. Most D-SNPs only meet the basic requirements to coordinate care, providing minimal integration. This presentation focused on factors influencing state decisions to integrate care. To better understand those factors and how the federal government could support states, MACPAC convened a roundtable of states.

This presentation included themes from the roundtable and a preview of policy options based on those themes. Commissioner feedback will guide staff development of policy options for discussion at an upcoming meeting. Selected options may be included in the June 2022 report to Congress.

Next, the Commission discussed a response to a Senate Finance Committee request for information on behavioral health priorities. In this session, staff reviewed a draft MACPAC response that draws on the Commission’s prior work on behavioral health. The draft response highlights key findings from MACPAC’s research, notes the Commission’s recommendations where relevant, and ongoing MACPAC analyses.

The meeting concluded with a panel discussion on the workforce for home– and community-based services (HCBS).* Robert Espinoza of PHI National, Bea Rector of Washington State’s Department of Social and Health Services, and Bill Kennard of the Arizona Healthcare Cost Containment System discussed current issues facing the HCBS workforce, including payment to agencies and wages paid to providers, training, and strategies for the recruitment and retention of workers.

* No presentation was prepared for this panel discussion.


  1. Data Availability for Monitoring Access to Care
  2. Analyses for Mandated Study on Money Follows the Person
  3. Vaccines for Adults Enrolled in Medicaid: Interview Findings
  4. Required Annual Analysis of Disproportionate Share Hospital Allotments
  5. Raising the Bar and Supporting State Efforts to Integrate Care for Dually Eligible Beneficiaries
  6. Response to Senate Finance Committee Request for Information on Behavioral Health Priorities