News Room

MACPAC Watch: January 2018

February 2, 2018 | Author: HealthTech Solutions

In their January 2018 meeting, the Medicaid and CHIP Payment and Access Commission (MACPAC) made at least one consequential recommendation on the Medicaid program: Allow expanded use of section 1932(a) State Plan authority for mandatory managed care programs. This recommendation will appear in their spring semi-annual Report to Congress.


Currently states may use section 1932(a) to implement a mandatory managed care program without a waiver, but only for limited populations. Some populations (e.g., duals, native Americans, and some children with special needs) are currently excluded from being required to enroll in managed care, but this recommendation suggests Congress revise the statute to allow all populations to be mandatory, if a state so requests.


The benefit for states is that they would have an indefinite approval for the program, whereas with a waiver, there are requirements around the cost of the program and recurring re-application and approval processes. You can find a chart here that compares the various aspects of managed care authority, including the state submission, budgeting, and monitoring burdens.


Many states have total or near-total mandatory managed care enrollment for their Medicaid population. They currently do this through a combination of State Plan, section 1115 demonstrations, and section 1915(b) waivers. If Congress adopts these recommendations and modifies the 1932(a) statute, this will decrease administrative burden on state and federal Medicaid staff.


The beneficiary protections for Medicaid managed care programs are under regulations at 42 CFR Part 438 and are not impacted by this change.