Congressional advisory panel makes recommendation to support the home-and community-based workforce
The Medicaid and CHIP Payment and Access Commission (MACPAC) released its March 2026 Report to Congress on Medicaid and CHIP today, with a recommendation to increase wage transparency for home-and community-bases services (HCBS) workers. The report also explores behavioral health in Medicaid and the State Children’s Health Insurance Program (CHIP), Medicaid for justice-involved youth, and Medicaid for children in foster care.
“Improving wage transparency for people who deliver care in home-and community-based settings will help states strengthen this vital workforce,” MACPAC Chair Verlon Johnson said. “This report also gives federal and state policymakers valuable insights into behavioral health use and spending in Medicaid and CHIP, as well as how Medicaid can meet the needs of some of the most vulnerable people it serves.”
Chapter 1 includes a recommendation aimed at bolstering the HCBS workforce by requiring states to report hourly wages paid to HCBS workers to help states set effective HCBS payment rates. Workforce shortages 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. Under this recommendation, states would gain access to more robust wage data, including comparison data from neighboring states, as a way to promote the HCBS workforce.
Chapter 2 focuses on behavioral health in Medicaid and CHIP. The Commission has had a long-standing interest in examining behavioral health service use and spending in Medicaid, given the program’s role as a major source of coverage for behavioral health services in the United States. However, analyzing behavioral health spending and utilization data in Medicaid and CHIP at a national level has historically been challenging. Behavioral health services do not have a standardized definition or well-defined set of procedure codes, provider taxonomies, or care settings, making it difficult to identify these services in medical claims. The chapter includes findings from the Commission’s analytic work to measure utilization and spending for Medicaid and Medicaid-expansion State Children’s Health Insurance Program (M-CHIP) enrollees with behavioral health conditions.
Chapter 3 looks at the role of Medicaid in supporting justice-involved youth. Medicaid has historically played a limited role in the care of incarcerated youth, but in recent years, federal Medicaid policy has shifted to focus on improving health care transitions for justice-involved youth as they reenter the community. The chapter includes findings from the Commission’s work on state efforts to improve care transitions for justice-involved youth who return to the community. It begins by providing an overview of the demographics and health needs of these youth, then reviews the federal Medicaid policy for eligible incarcerated individuals. It concludes with findings from interviews with selected states on their efforts to implement these requirements and challenges in implementation.
Chapter 4 provides an overview of how Medicaid meets the needs of children in child welfare. Children and youth in the child welfare system represent a small but highly vulnerable segment of the Medicaid-enrolled population. The chapter includes background information about children and youth in foster care, their health status, and health care utilization. Next, it highlights key federal requirements for child welfare and Medicaid state agencies. The chapter concludes with selected considerations for states in providing health care access to children in foster care based on MACPAC’s review of seven states.
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ABOUT MACPAC
The Medicaid and CHIP Payment and Access Commission is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide array of issues affecting Medicaid and the State Children’s Health Insurance Program (CHIP). For more information, please visit: www.macpac.gov.