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MACPAC Releases Annual Report to Congress

The Medicaid and CHIP Payment and Access Commission (MACPAC) released its March 2018 Report to Congress, which includes the commission’s statutorily required annual analysis of Medicaid disproportionate share hospital (DSH) payments.

This year’s report also includes chapters on Medicaid managed care and telehealth.

Analysis of DSH

The report explores the relationship between DSH allotments and related factors, such as hospital uncompensated care costs and services for low-income, uninsured, and vulnerable populations. The commission found that total hospital charity care continued to fall in 2016, while Medicaid shortfall increased due to higher enrollment under Medicaid expansion.

The report also includes updated statistics about hospital margins. In 2015, deemed DSH hospitals reported lower aggregate operating margins than other hospitals — negative 0.3 percent compared with 1.6 percent, respectively. Without DSH payments, deemed DSH hospital margins would have been about four percentage points lower.

The report also highlighted the potential impact of Affordable Care Act-mandated Medicaid DSH allotment reductions on states. The commission notes that reductions have been delayed several times and now are scheduled to take effect in fiscal year 2020.

Managed Care, Telehealth Recommendations

Meanwhile, the report contains recommendations for streamlining managed care authority, recognizing that the percentage of beneficiaries enrolled in a form of managed care continues to climb.

The last chapter highlights the potential for telehealth to expand behavioral health and maternity services in low-access areas and among individuals using home- and community-based services.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Rachel Schwartz is a policy associate at America's Essential Hospitals.