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 March meeting began with a discussion on the role of automation in the Medicaid prior authorization (PA) process. MACPAC conducted a literature review, a federal policy review, and stakeholder interviews on the role of automation in the PA process. During this session, we reviewed findings and challenges that surfaced in this research, including the extent to which automation is already in use in Medicaid PA; the availability of information and documentation about the use of automation; the current state and federal policy landscape specific to automation in PA; and the potential risks posed by its adoption. Staff presented draft policy options for Commission consideration.

Next, the Commission continued its focus on the use of managed care accountability tools. Staff reviewed key findings from stakeholder interviews and analysis of the Managed Care Program Annual Reports available from the Centers for Medicare & Medicaid Services (CMS), identifying the opportunities and barriers to effective oversight that emerged from our study. Staff then presented draft policy recommendations to address the opportunities to improve managed care plan accountability. The proposed recommendations seek to improve the usability of managed care performance data and provide states with additional guidance and tools to more effectively assess and oversee plan performance.

The Commission then looked at appropriate access to residential treatment services for Medicaid-enrolled youth. MACPAC staff began with an overview of key findings and challenges with access, and highlighted new information on federal efforts to create systems for tracking beds. Staff reviewed draft policy recommendations based on earlier feedback from Commissioners. These draft policy recommendations seek to address the absence of easily accessible, public information on facility and bed availability; the availability of data on use of residential care, in particular in out-of-state facilities; and strengthening discharge planning requirements, including for youth in out-of-state residential treatment.

After this, staff presented six draft policy recommendations to address challenges related to transitions of coverage for children and youth with special health care needs (CYSHCN). The draft recommendations include directing CMS to require states to send 60-day advance notice to CYSHCN aging out of child eligibility; states to provide up to 30 days for beneficiaries to respond to requests for information in eligibility redeterminations; CMS to coordinate with the Social Security Administration on model notice language; CMS to issue guidance to states on supporting CYSHCN transitions to adult coverage; states to adopt the state option for Medicaid coverage for CYSHCN not otherwise covered; and Congress to amend the statute to implement 12-month continuous eligibility for CYSHCN aging out of child eligibility pathways.

To conclude the day, staff presented on the Program of All-Inclusive Care for the Elderly (PACE) model, which provides fully integrated care to frail adults ages 55 and older who meet nursing-facility level of care criteria and can live safely in the community. Findings in the June 2025 report to Congress raised questions about transparency, particularly around state and federal monitoring of PACE compliance and quality. In January 2026, staff presented results from a review of three key oversight documents: required three-way program agreements among CMS, states, and PACE organizations; optional two-way agreements between states and PACE organizations; and waiver requests submitted under Section 903 of the Medicare, Medicaid, and the SCHIP Benefits Improvement and Protection Act of 2000 (P.L. 106-551) (BIPA 903 waivers). These documents define state authority and responsibilities but provide limited detail on the implementation of oversight activities or coordination between states and CMS.

In this session, staff presented findings from interviews with state Medicaid officials, CMS staff, and PACE experts to identify ways to address these gaps. Interview findings highlight state interpretation of oversight roles, monitoring beyond the initial three-year period, assessment of performance and quality, use of oversight tools, and coordination with federal partners. MACPAC found variation in state approaches, differences in oversight capacity, and areas of overlap or ambiguity between state and federal responsibilities.

On Friday, the Commission looked at Medicaid provider enrollment and managed care credentialing requirements designed to ensure that Medicaid enrollees receive care from qualified providers. As part of the Commission’s continued focus on access to care for Medicaid enrollees, MACPAC examined federal and state policies as well as academic and grey literature. In this session, staff presented a draft chapter that summarizes findings from that work. The presentation outlined federal requirements for provider enrollment and credentialing and provided an overview of those processes. Staff then discussed provider enrollment requirements for select provider types and challenges that emerged from the literature.

Next, staff presented on mandatory and optional services in Medicaid. Federal statute and regulations mandate coverage of certain populations and benefits and define optional populations and services that states may cover in their Medicaid programs. States design their programs within federal requirements to meet specific needs and priorities. MACPAC presented an analysis of enrollment and spending for mandatory and optional enrollees and services using data from the Transformed Medicaid Statistical Information System (T-MSIS) and the CMS-64 net financial management report for fiscal year 2023.

To conclude the meeting, staff provided highlights from the February 2026 Edition of MACStats: Medicaid and CHIP Data Book, which compiles the most current data available on Medicaid and the State Children’s Health Insurance Program (CHIP) into a single publication.

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.