Report to Congress on Medicaid and CHIP

Executive Summary: March 2015 Report to Congress on Medicaid and CHIP The Medicaid and CHIP Payment and Access Commission (MACPAC) releases its March 2015 Report to Congress on Medicaid and CHIP at a time of critical change for both of these programs.

The State Children’s Health Insurance Program (CHIP) confronts exhaustion of federal funds, with the last allotments to states being made under current law in fiscal year (FY) 2015. MACPAC began analyzing the implications of this scenario in its March and June 2014 reports to Congress, documenting problems with affordability and adequacy of both exchange plans and employersponsored insurance for children who would lose CHIP coverage.

In those reports, the Commission recommended extending CHIP for two years while these issues could be addressed. The first four chapters of the March 2015 report to Congress follow up on that recommendation in depth. Meanwhile, Medicaid, which this year marks a halfcentury of providing access to health care for the most disadvantaged Americans, is expanding. As a result of the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended), in over half of states, a new group of low-income adults became eligible for Medicaid in 2014, alongside the populations Medicaid has traditionally covered: low-income families with children, pregnant women, people age 65 and older, and people with disabilities. The March report offers perspective on two approaches being tested in Iowa and Arkansas to use Medicaid funds to purchase exchange coverage for the new adult group.

The Commission also looks closely at whether current policies for Medicaid payment of Medicare cost sharing affect access to care for the 20 percent of beneficiaries who are dually eligible for these programs. The report also outlines a new payment framework to examine how payment and delivery systems meet statutory principles of economy, quality, access, and efficiency. It concludes with an update on the primary care payment increase that expired in December 2014.