MACPAC pushes Congress to streamline state shifts to managed care

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In a report issued Wednesday, MACPAC urged Congress to make transitioning to managed care easier for states — one method the commission suggested could improve efficiency within the Medicaid system.

Eighty percent of beneficiaries now receive healthcare through managed care, MEDPAC reported, while suggesting three specific strategies that would reduce administrative barriers for states “without reducing beneficiary protections.”

But several recent studies indicate managed care enrollees — including many in long-term care — don't always get the best care when compared to their fee-for-service peers.

A Brown University study found Medicare Advantage enrollees appear more likely to enter lower-quality skilled nursing facilities than people enrolled in traditional fee-for-service Medicare.

A separate report by the Kaiser Family Foundation showed one out of every five MA plans did not include in its preferred provider network a regional academic medical center — institutions that usually offer the highest-quality care and specialists.

The commission did not mention those shortcomings in addressing how to improve access to Medicaid Advantage. About 65 percent of nursing home residents are supported primarily by Medicaid.

MACPAC recommended Congress:

•  allow states to require all beneficiaries to enroll in Medicaid managed care programs under state plan authority,

•  extend approval and renewal periods for all Section 1915(b) waivers from two to five years, and

•  revise waiver authority to permit states to to revoke freedom of choice and selective contracting.

National Association of Medicaid Directors head Matt Salo told Bloomberg Law that state Medicaid directors endorse the recommendations “100 percent” and that making long-standing waivers permanent would be “a sensible and welcome first step.”