Bicameral Leaders Request Details on Coverage of Optional State Medicaid Eligibility and Benefit Categories

In Letter to MACPAC, Members Detail Need for Better Understanding of States’ Coverage of Optional Categories in Nation’s Largest Health Insurance Program

WASHINGTON, DC – Bicameral leaders today sent a letter to the Medicaid and CHIP Payment and Access Commission (MACPAC) requesting they analyze the optional Medicaid eligibility and benefit categories that states have chosen to cover and spending for those categories. The letter was sent by Senate Finance Committee Chairman Orrin Hatch (R-UT), Chairman Greg Walden (R-OR), Oversight and Investigations Subcommittee Chairman Tim Murphy (R-PA) and Health Subcommittee Chairman Michael C. Burgess, M.D. (R-TX).

The largest health insurance program, Medicaid, covered more than 77 million people last year. This year, the Congressional Budget Office (CBO) estimates the program will be used by as many as 98 million Americans.
“…[We] believe it is important to better understand the optional eligibility groups and optional benefits States are covering. Clearly, some optional benefits – such as prescription drug coverage – are important for virtually all beneficiaries,” wrote Hatch, Walden, Murphy and Burgess. “Yet other benefits may be more necessary as a covered benefit for a subset of beneficiaries. However, this information is not easily discernable in one source for each state. Instead, this information exists across multiple, disaggregated sources that make meaningful review a challenge. The information currently available from the Centers for Medicare & Medicaid Services is limited to a list of mandatory and optional eligibility groups, as well as mandatory and optional benefits.”

Committee leaders continued, “Congress in particular needs to have the most comprehensive and current information available, especially given that CBO warns that federal spending for mandatory programs and net interest will exceed total federal revenues by the 2027 – 2036 period. Without action, the unrestrained spending on Medicaid, which increases for each benefit and individual covered, could crowd out funding for other critical State and federal priorities like education, criminal justice enforcement, and transportation.”

Click HERE to read a copy of the letter.

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