MACPAC’s Focus on HCBS Highlights Streamlining Opportunities

The Medicaid and CHIP Payment and Access Commission (MACPAC) convened in its November meeting last Friday, exploring various critical topics in the realm of Medicaid and health care accessibility. Notably, MACPAC delved into the challenges and opportunities surrounding Home and Community Based Services (HCBS), aiming to streamline administrative complexity. This session emphasized comparing federal requirements across different Section 1915 authorities, with insights gleaned from policy experts, states, and federal officials. Additionally, the meeting delved into Medicaid payment policies for HCBS workers, identifying five key policy issues for further examination:

1. The data used to develop fee-for-service (FFS) rate setting;
2. Budget constraints that affect a state’s ability to finance HCBS rates at levels recommended during the rate-setting process;
3. The use of self-directed services and managed care to pay rates that may differ from FFS;
4. Policies to regulate the share of HCBS payments agencies spend on HCBS worker wages; and
5. Non-financial policies to increase HCBS worker recruitment and retention.