The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) created the Medicaid and CHIP Payment and Access Commission (MACPAC) to advise Congress on a wide range of Medicaid and CHIP issues. MACPAC will start operating in early 2010.

MACPAC Membership and Staff:

Modeled closely after the long standing and highly influential Medicare Payment Advisory Commission (MedPAC), MACPAC will be a Congressional agency like MedPAC, the Congressional Budget Office (CBO), and the Government Accountability Office (GAO). Like MedPAC, the 17-member MACPAC will include an executive director and a professional staff of ~25-40. MACPAC appoints the executive director.

The 17 Commission members will be appointed for three-year, staggered terms, by the Comptroller General (head of the GAO), with representation from health financing experts, physicians, health professionals, employers, third-party payors, consumers, and current or former state Medicaid / CHIP officials. Non-health care providers must constitute a majority of the MACPAC membership. MACPAC appointments must be made by January 1, 2010.

Qualifications for MACPAC Membership:

In general, MACPAC’s membership must include individuals with direct experience as:

  • Medicaid / CHIP beneficiaries or parents of beneficiaries.
  • Individuals with national recognition for expertise in Medicaid, CHIP, health finance and economics, actuarial science, health plans, integrated health systems, reimbursement, health information technology, or health care providers (e.g., pediatricians, dentists).

In particular, the MACPAC membership must include physicians and other health professionals, employers, third-party payors, and individuals with expertise in the delivery of health services. This must include:

  • Members representing children, pregnant women, the elderly, and individuals with disabilities
  • Current or former state Medicaid agency officials.
  • Current or former State CHIP agency officials.

Congress seeks a mix of different professionals, broad geographic representations, and a balance between urban and rural representatives.

Role and Duties of MACPAC in Advising Congress on Medicaid and Children’s Health Insurance Program:

Starting in 2010, MACPAC will:

  • Review Medicaid and CHIP policies affecting children’s access to covered services and make recommendations to Congress, with a report due by March 1 each year.
  • More broadly examine issues affecting Medicaid and CHIP, including implications of changes in care delivery and the marketplace. Make recommendations to Congress, with report due by June each year.

More specifically, Congress directs MACPAC to regularly review and assess:

  • Medicaid and CHIP payment policies, including state payment methodologies and factors affecting expenditures in different sectors, including the process for updating reimbursement rates for hospitals, nursing facilities, physicians, and community health centers.
  • The relationship of payment policies to access and quality of care for Medicaid and CHIP beneficiaries.
  • Interaction of Medicaid and CHIP payment policies with health care delivery.
  • Implications of health care delivery changes and other marketplace changes on access to care for Medicaid and CHIP beneficiaries.
  • The effect of other Medicaid and CHIP policies on access to covered health care services, including transportation and language barriers.

MACPAC must also:

  • Create an early warning system to identify provider shortage areas or any other problems that threaten access to care or the health care status of Medicaid and CHIP beneficiaries.
  • Review and comment to Medicaid and CHIP related reports to Congress by HHS.
  • Upon request of committee chairs or ranking members, conduct studies, produce special reports, and make recommendations to Congress on Medicaid and CHIP issues.
  • Periodically consult with Congressional leadership (committee chairs and ranking members), make its reports available to the HHS Secretary and the public, record and report votes on all recommendations, and examine the budget consequences of recommendations.
  • Before making any recommendations, MACPAC must consider the budget consequences of such recommendations, directly or through consultation with experts.

CHIPRA also contains provisions on MACPAC operations, data collection and access, authority, funding and staffing. Again, these closely align with existing policies governing MACPAC’s sister agency MedPAC.

Committee Jurisdictions in Congress:

MACPAC will be accountable to the Congressional committees with jurisdiction for Medicaid and CHIP, namely: