June 2019 Report to Congress on Medicaid and CHIP

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June 2019

In the June 2019 Report to Congress on Medicaid and CHIP, MACPAC responds to congressional requests for analysis and makes recommendations on Medicaid payment and coverage policies for outpatient prescription drugs, hospital payment, program integrity, therapeutic foster care, and challenges facing Puerto Rico’s Medicaid program.

Chapter 1 addresses improving prescription drug policy under Medicaid, making recommendations to support states in developing appropriate drug coverage criteria and to make changes in the federal drug rebate program that will reduce spending in a sector that is expected to experience one of the largest growth rates among health care goods and services over the next 10 years.

Chapter 2 reviews the implications of changing policy affecting how Medicaid shortfall is calculated for the purposes of disproportionate share hospital (DSH) payments. It also lays out the Commission’s recommendations for statutory changes that will reverse the effects of a recent federal district court ruling and ensure that DSH payments do not pay for costs that are paid for by other payers.

Chapter 3 presents the Commission’s recommendation to the Secretary of the U.S. Department of Health and Human Services (HHS) regarding how the federal government could better support states in their efforts to improve program integrity in their Medicaid programs, and for a statutory change to remove the mandate that all states procure a recovery audit contractor.

Chapter 4 responds to a request by the House Appropriations Committee, asking MACPAC to analyze whether a uniform definition of therapeutic foster care could promote more consistent care and treatment for children and youth who have serious emotional, behavioral, developmental, or medical conditions. The Commission recommends that the HHS Secretary provide guidance to states on how to cover therapeutic foster care, and how to coordinate services across agencies.

Chapter 5 responds to a congressional request to examine how to ensure sustainable access to care for Medicaid beneficiaries in Puerto Rico. Although the chapter contains no recommendations, the Commission notes that ensuring long-term, reliable, sustainable access will likely require changes to federal financing policies for Puerto Rico’s Medicaid program.

Publication Type: Reports to Congress

Report Chapters

Tags: access, behavioral health, benefits, children, disproportionate share hospital (DSH) payment, Early and Periodic Screening Diagnostic and Treatment (EPSDT), enrollment, federal financial participation (FFP), Federal Medical Assistance Percentage (FMAP), federal/state partnership, financing, foster children, hospitals, prescription drugs, program integrity, spending, supplemental payments, waste/fraud/abuse