MACPAC’s Agenda for the 2025-2026 Meeting Cycle

Want to stay up to date on some of the topics that the Medicaid and CHIP Payment and Access Commission (MACPAC) will address during our 2025-2026 meetings? Here's a look at some of MACPAC's upcoming areas of focus in Medicaid policy.

Our analytic agenda includes, but is not limited to:

Enrollment and eligibility

Community engagement

MACPAC will monitor federal and state efforts to implement newly mandated Medicaid work and community engagement requirements. We will also examine the factors and considerations affecting implementation.

Transitions of care for children and youth with special health care needs (CYSHCN)

MACPAC will continue to examine how Medicaid policy addresses eligibility transitions in coverage from pediatric to adult care for CYSHCN and whether there are barriers to these transitions that could be addressed in federal policy. We will also analyze Medicaid administrative data to better understand coverage for beneficiaries aging out of child and into adult eligibility groups.

Managed care

Artificial intelligence in prior authorization

We will expand our existing body of work to examine the extent to which automation is used in prior authorization, the key issues related to prior authorization, and the extent to which states and managed care organizations (MCOs) use technological tools to automate parts of the prior authorization decision-making process, including artificial intelligence.

Managed care accountability

Managed care is the primary delivery system in Medicaid, with almost three out of every four Medicaid beneficiaries enrolled in managed care. MACPAC will continue to explore the tools that states and the Centers for Medicare & Medicaid Services (CMS) are currently using to oversee MCO performance.

Program Integrity

Federal role in program integrity

MACPAC will begin an examination of the role of federal agencies in ensuring Medicaid program integrity and the federal policy levers to support and monitor state efforts. This work will highlight the varied federal agencies involved in program integrity and consider how their roles and activities complement each other.

Behavioral health

Residential treatment programs for youth

As part of our multi-year work plan to address the needs of youth with serious behavioral health needs, we will continue a conversation about access to appropriate services in residential treatment programs. Specifically, we will look at whether states have the tools they need to provide access to residential treatment to children and youth enrolled in Medicaid who need such care.

Utilization management for medications for opioid use disorder (MOUD)

MACPAC will continue to examine access to MOUD by assessing the use of prior authorization for MOUD, daily dosage caps, and refill thresholds in Medicaid. Specifically, our work will consider whether such strategies enable states and MCOs to manage costs and prevent overuse and diversion while also ensuring appropriate and timely access to MOUD.

Behavioral health spending and utilization

MACPAC will analyze Medicaid administrative data to quantify the prevalence of behavioral health conditions, beneficiary use of health services, and expenditures. Our analysis will explore spending for beneficiaries with and without behavioral conditions, and compare spending by different demographic characteristics, place of service, and diagnosis.

Provider payment

Hospital payment

MACPAC will continue its work exploring whether hospital payment policies are consistent with the Medicaid statutory goals of economy, efficiency, quality, and access. We will examine how Medicaid payment relates to drivers of hospital costs.

Long-term services and supports

Assistive technology

MACPAC will begin new work to understand how Medicaid covers assistive technology. Our focus is on access to the benefit for adults using home-and community-based services (HCBS) and how assistive technology may be used as a tool to increase independence and lessen the burden on the HCBS workforce.

Self-directed HCBS

MACPAC will continue its work on self-direction, aiming to better understand how it operates under the broader Medicaid HCBS assurances for beneficiary health and welfare in Medicaid regulations. Our goal is to assess whether additional tools are needed for states and for CMS to protect Medicaid beneficiaries who self-direct.

Program of All-Inclusive Care for the Elderly (PACE)

In a follow up to our June 2025 Report to Congress, MACPAC will continue its work on PACE to better understand the role state Medicaid agencies play in administering and overseeing PACE. We will examine responsibilities reserved for states, the tools and strategies they use, and barriers that may impact their ability to fulfill these responsibilities.

We hope you'll tune in to our meetings as we share this work. Sign up for our mailing list on our website today so you don't miss out: https://www.macpac.gov/