Capitol Correspondence - 03.17.20

MACPAC March Report to Congress Discusses Evaluation of Medicaid Demonstrations

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Medicaid funds the majority of disability supports in the United States, including through demonstration programs such as Money Follows the Person (MFP), which helps people with disabilities voluntarily move into the community. This makes the Medicaid and CHIP Payment Access Commission’s (MACPAC) March report to Congress on evaluating Medicaid demonstrations of interest to readers seeking to stay informed on broader discussions surrounding Medicaid.

As summarized by MACPAC:

“The Medicaid and CHIP Payment and Access Commission (MACPAC) today released its March 2020 Report to Congress on Medicaid and CHIP, highlighting three issues of ongoing interest to Congress: payment to safety-net hospitals; the quality of behavioral health care and care provided to children who have health coverage through Medicaid or the State Children’s Health Insurance Program (CHIP); and the timeliness and quality of evaluations of Medicaid demonstrations.

‘This report looks at several timely policy questions,’ said MACPAC Chair Melanie Bella. ‘How well do federal policies for making disproportionate share hospital (DSH) payments relate to measures of need such as the level of uncompensated care and rate of insurance coverage? Will states be ready to meet an upcoming statutory deadline for reporting on quality measures for behavioral health and children’s care? And, what can be done to ensure that evaluations of Section 1115 waivers produce useful information for policymakers?’


Chapter 3 discusses state-led evaluations of demonstration programs conducted under Section 1115 waiver authority and the usefulness of these evaluations to support decision making. Given the importance of gathering evidence to inform decisions about the future of a demonstration policy, states should be rigorous in the measures and data sources they use to assess whether the demonstration is making progress toward its objectives. Among other issues, the chapter addresses methodological and administrative challenges states face in conducting these statutorily required evaluations. The chapter relied heavily on perspectives shared at a November 2019 MACPAC roundtable of state and federal Medicaid officials, evaluators of state demonstration programs, researchers, and other stakeholders. Although the Commission did not identify a need for action at this time, it plans to continue to monitor how states and CMS carry out evaluations and how evaluations are used in decision making.”