Health Reform WK-EDGE Sen. Cassidy reintroduces the Medicaid Accountability and Care (MAC) Act
Friday, March 10, 2017

Sen. Cassidy reintroduces the Medicaid Accountability and Care (MAC) Act

By Harold Bishop, J.D.

Senator Bill Cassidy, MD (R-La.) reintroduced a bill that would establish a federal base payment for each Medicaid eligible beneficiary, with the base payment adjusted for factors that affect the cost of care. The bill would not repeal the Medicaid expansion, but would change Medicaid in the 31 expansion states by capping Medicaid eligibility at 100 percent of the federal poverty level (FPL), down from the 138 percent of the FPL allowed under section 2001 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). Concerns with the bill are that the individual entitlement to Medicaid services would be eliminated under a per beneficiary payment system and that long-term services and other support needs of individuals with significant disabilities might exceed the average per person payment.

Under Cassidy’s Medicaid Accountability and Care (MAC) Act of 2017, the federal government would reimburse states with a per beneficiary payment for each Medicaid beneficiary, with different rates for each of the four major Medicaid beneficiary groups:

  • aged,
  • blind and disabled,
  • children, and
  • adults.

The federal government would pick up 75 percent of the cost, and states would get bonuses if they achieve the best quality health care, plus keep all savings achieved from crackdowns against fraud, waste and abuse. Under the MAC Act, the per beneficiary payment follows the patient. This means that the government would not be able to spend money without thinking about patient care and needs.

According to Cassidy, the current Medicaid system is costly, does not guarantee access to care or improved health outcomes, and there are huge payment disparities among states. "As a doctor, treating patients in a public hospital for the uninsured for 25 years, I’ve seen that Medicaid offers the illusion of coverage without the power of access," said Cassidy. "Modernizing how Medicaid is financed can incentivize more efficient, effective and patient-centered care. The MAC Act does this."

In addition to reducing disparities in state payments, the MAC Act is designed to improve Medicaid financing through controlled spending, value-based incentives, and fraud reduction. The bill would also allow cost-sharing with fewer restrictions as it exists under current law, in order to promote greater value and combat over-utilization. The individual states would also be given significant latitude in developing enforcement mechanisms.

Cassidy originally introduced the MAC Act of 2013 in the 113th Congress.

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