MACPAC Releases June Report to Congress
The Situation Report | June 23, 2025
The Medicaid and CHIP Payment and Access Commission (MACPAC) recently released its June report to Congress, one of two mandated reports that MACPAC publishes each year. The June report contains five chapters, though only one of the chapters makes formal recommendations.
HCANYS highlights the following three chapters that might be of interest to members:
- Children and Youth with Special Health Care Needs Transitions of Care
- Understanding the Program of All-Inclusive Care for the Elderly
- Self-Direction for Home- and Community- Based Services
Children and Youth with Special Health Care Needs Transitions of Care
In this chapter, MACPAC discusses the challenges that children with special needs face when they age into adult-care. For these individuals, their eligibility for certain services is terminated by the end of eligibility for the Early and Pediatric Screening Diagnostic Treatment (EPSDT) benefit, which can also result in more stringent limits on the amount of covered services. Additionally, children aging into adult services may also need to switch providers if their previous care-source is limited to pediatric clients. In the chapter, MACPAC makes the following recommendations:
- Congress should require that all states develop and implement a strategy for transitions from pediatric to adult care for children and youth with special health care needs, including developing and implementing an individualized transition of care plan.
- The U.S. Centers for Medicare and Medicaid Services (CMS) should issue guidance to states on existing authorities for covering transition of care services for children and youth with special health care needs.
- CMS should require states to collect and report to CMS data to understand (1) which beneficiaries are receiving services to transition from pediatric to adult care, (2) utilization of services that support transitions of care, (3) and receipt of an individualized transition of care plan.
Understanding the Program of All-Inclusive Care for the Elderly
MACPAC provides an overview of the Program of All-Inclusive Care for the Elderly (PACE), which is a program for enrollees age 55 or older and require a nursing facility level of care. PACE serves more than 83,000 individuals across 33 states and the District of Columbia, most of whom are dually eligible for Medicaid and Medicare. In 2023, combined state and Federal spending on PACE was $3.9 billion. MACPAC identified two key areas of complexity in administering PACE: unclear delineation of oversight responsibilities and a lack of data on service utilization. The report does not provide any thoughts on potential recommendations in the future.
Self-Direction for Home- and Community- Based Services
In chapter five, MACPAC examines the use of self-direction in state HCBS programs around the country, including a detailed discussion of the different models, statutory authorities, and service delivery methods. In 2023, MACPAC reported that over 1.5 million individuals were enrolled in some type of self-direction program, with self-direction available in all 50 states. Self-direction models varied significantly across states regarding the populations and services eligible for inclusion in these programs. Similarly, methods of administration and oversight were equally varied, involving outside contractors, financial management agencies, managed care plans, and other entities. Though states had a wide range of methods for providing oversight, there were limitations regarding the success of these controls.
HCANYS staff will further conduct a comprehensive review of the MACPAC report and determine appropriate adovcacy and member education efforts based on the findings. HCANYS members can access the full MACPAC Report here.