Members of the Medicaid and CHIP Payment and Access Commission met recently in Washington, D.C.

The following is MACPAC’s own summary of its two days of public meetings.

MACPAC’s September 2025 meeting began with a summary of Public Law 119-21, an Act to Provide for Reconciliation Pursuant to Title II of H. Con. Res. 14 (2025 Budget Reconciliation Act, P.L. 119-21). This legislation included several provisions affecting Medicaid and the State Children’s Health Insurance Program (CHIP). In this session, staff provided a summary of the Medicaid and CHIP-related provisions in the 2025 Budget Reconciliation Act.

Staff then presented on work and community engagement requirements in Medicaid. States will soon be required to make Medicaid eligibility for certain applicants and existing beneficiaries contingent on their participation in qualifying community engagement activities in accordance with the 2025 Budget Reconciliation Act (P.L. 119-21). The presentation also outlined the history of work and community engagement requirements in Medicaid, including the experiences of states that implemented such requirements under Section 1115 demonstration authority.

Next, the Commission heard an expert panel discussion on considerations for implementing Medicaid community engagement requirements, including areas where states would benefit from timely federal guidance.

Panelists included:

    • Melisa Byrd, senior deputy director and Medicaid director, District of Columbia Department of Health Care Finance
    • Jessica Kahn, partner, McKinsey & Company
    • Jennifer Strohecker, integrated healthcare division and Medicaid director, Utah Department of Health and Human Services
    • Deanna Williams, enrollment assister, Georgians for a Healthy Future

After a break, staff presented a draft recommendation for Commissioner consideration to promote the home- and community-based services (HCBS) workforce. HCBS workforce shortages hamper Medicaid’s ability to serve people with long-term care needs in the home or community. Although some factors that affect the HCBS workforce are outside of Medicaid’s purview, many states use Medicaid rate setting to expand the HCBS workforce and reduce worker turnover. In previous MACPAC public meetings, staff discussed findings from a compendium of HCBS authorities, federal and state interviews, and a technical expert panel that explored strategies to ensure that HCBS payment rates are adequate to attract and retain a sufficient workforce.

Staff then highlighted key aspects of Medicaid’s role in covering behavioral health services for beneficiaries in Medicaid and CHIP. The session also reviewed MACPAC’s prior work on utilization and spending on behavioral health before introducing new claims data analysis, including variables that will be examined.

To conclude the day, staff provided an overview of relevant Medicaid eligibility pathways for children and youth with special health care needs and how they can receive HCBS. The presentation included key findings from the federal and state policy scan and how these policies apply to the processes of transitioning to adult Medicaid and transitioning between child-only and adult Section 1915(c) HCBS waivers.

On Friday, the meeting began with a staff presentation on a draft chapter for the March 2026 Report to Congress based on a study of how Medicaid meets the needs of children in child welfare. Staff summarized the draft chapter, which included background information about children and youth in foster care, their health status, and their health care utilization. Staff highlighted key federal requirements for child welfare and Medicaid state agencies. Next, staff described select challenges and considerations for states in providing health care access to children in foster care based on our review of seven states with varied Medicaid delivery systems. The Commissioners provided feedback on the draft chapter.

Following this, staff provided background information on the characteristics and health needs of justice-involved youth, as well as Medicaid’s role in supporting their transition from incarceration back to the community.

Next, staff provided a legislative summary of the American Rescue Plan Act of 2021 (ARPA, P.L. 117). The legislation provided Medicaid programs with $37.1 billion in one-time funding for state-driven HCBS reinvestment activities through a temporary increase in the federal medical assistance percentage. Since ARPA’s enactment, MACPAC has monitored state efforts to spend the funds and is working to understand state experiences with implementation, particularly given the size of the investment and the compressed timeline states had in which to spend it. This session provided a legislative summary of ARPA and background on timelines and guidance associated with its implementation, as well as key takeaways from MACPAC’s monitoring efforts related to timing, program evaluation, and sustainability.

To conclude the meeting, staff presented on the Medicare-Medicaid Plan (MMP) transition. The Centers for Medicare & Medicaid Services (CMS) in 2022 finalized rulemaking that ended the Financial Alignment Initiative (FAI), a demonstration program intended to test models that could increase financial alignment between Medicaid and Medicare while integrating primary care, acute care, behavioral health services, and long-term services and supports for dually eligible beneficiaries. Several models were offered under the demonstration, but most participating states signed on to the MMP, a capitated model with a three-way contract among CMS, the state Medicaid agency, and the health plan.

CMS allowed states to continue their demonstrations through the end of 2025 if they submitted tentative plans for transitioning their MMP populations to integrated dual-eligible special needs plans, a Medicare Advantage product that only enrolls those who are dually eligible for Medicaid and Medicare and provides coverage according to a model of care. These plans also coordinate or cover Medicaid benefits. In this presentation, staff provide Commissioners with updates on state procurement, information technology system changes, enrollment processes, and stakeholder engagement, including communication with MMP enrollees.

During the course of its deliberations MACPAC’s staff made the following presentations to the commissioners:

Find a transcript of the MACPAC meeting here.

MACPAC is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide variety of issues affecting Medicaid and the State Children’s Health Insurance Program.  Its deliberations are highly influential among policymakers.  Find MACPAC’s web site here.