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MACPAC Report to Congress Examines CHIP, Premium Assistance Waivers

The Medicaid and CHIP Payment and Access Commission’s (MACPAC’s) March 2015 Report to Congress focuses on the potential impact of Children’s Health Insurance Program (CHIP) funding expiring, premium assistance waivers used to expand Medicaid coverage, and aspects of Medicaid payment.

Current funding for CHIP is set to expire at the end of 2015. The commission found that as many as 1.1 million children would lose coverage if funding is not extended. The commission did note that many children currently covered by CHIP would be able to obtain coverage through a health insurance marketplace or employer-sponsored coverage. But that may result in higher out-of-pocket costs with fewer pediatric benefits. The commission echoed its previous recommendation for Congress to extend CHIP funding for an additional two years. America’s Essential Hospitals is a strong proponent of increasing access to affordable health coverage for all and has provided support letters to Congress on the need for a CHIP funding extension.

The March report also examined the premium assistance waivers that expanded Medicaid coverage in Arkansas and Iowa. Through Section 1115 research and demonstration waivers, these states were able to pursue an alternative to the Affordable Care Act’s (ACA’s) Medicaid expansion. The commission found that this approach has succeeded in reducing the number of uninsured adults, but notes that monitoring is needed to ensure beneficiaries are still receiving appropriate services and that the waivers provide value to taxpayers. Other states have expressed interest in pursuing a similar approach and the commission noted that it will continue to monitor the demonstrations.

Lastly, the report examined several aspects of Medicaid payment. One of these aspects is Medicaid coverage of Medicare cost-sharing and how it affects access to care. Since its inception, the Medicaid Program has assisted in the payment of premiums and cost-sharing for low-income Medicare beneficiaries. These beneficiaries are known as dual-eligibles, as they are eligible for both Medicaid and Medicare coverage. Another Medicaid payment aspect studied by MACPAC is the now expired primary care payment increase. The ACA included a provision that temporarily raised primary care providers’ Medicaid fees to Medicare payment levels. The commission notes that some states have continued to pay Medicaid primary care providers at a higher rate, but it is still too early for the commission to assess the impact of this payment policy.

MACPAC is a nonpartisan legislative branch agency tasked with providing policy and data analysis and making recommendations to Congress, the secretary of the U.S. Department of Health and Human Services, and the states on issues pertaining to the Medicaid program and CHIP. The commission is required to submit two annual reports to Congress each year, one in March and one in June.

Contact Beth Feldpush, DrPH, senior vice president of policy and advocacy, at or 202.585.0111 with questions.


About the Author

Zina Gontscharow is a former senior policy analyst for America's Essential Hospitals.

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