Applied Policy regularly reports on the meetings and recommendations of the Medicare Payment Advisory Commission (MedPAC) and the Medicaid and CHIP Payment and Access Commission (MACPAC). Herein, we explore how these commissions are structured, their roles, and their influence on policy.

Origins and Statutory Authority

MedPAC provides guidance on Medicare policy. It was established through the merger of the Prospective Payment Assessment Commission (ProPAC) and the Physician Payment Review Commission (PPRC) under the Balanced Budget Act of 1997.​ As Mark Miller, PhD, former executive director of MedPAC, who served on the commission for 15 years has observed, MedPAC considers issues from three perspectives: that of the beneficiary, that of the provider, and that of the taxpayer.

Modeled after MedPAC, MACPAC was established by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) to examine Medicaid and the Children’s Health Insurance Program (CHIP). Its responsibilities were further clarified, and its funding increased with the passage of the Affordable Care Act in 2010. MACPAC’s work spans a broad range of policy areas, including Medicaid and CHIP enrollment and retention, coverage policies, quality of care, interactions between Medicare and Medicaid, and access to services and payments for dually eligible individuals.

Observers quickly recognized MACPAC’s potential influence, particularly in shaping Medicaid benefit policies and access to care and high-cost treatments such as growth hormone therapies.

Although neither commission has regulatory authority, their research and recommendations play a critical role in shaping federal healthcare policy, influencing both legislative initiatives and regulatory decisions by CMS.

General Comparison

 

	MedPAC	MACPAC
Established by	Balanced Budget Act of 1997	CHIPRA (2009), expanded by ACA (2010)
Codified at	42 U.S.C. § 1395b-6	42 U.S.C. § 1396
Focus	Medicare payment policy, access, and quality	Medicaid and CHIP payment, access, and financing
First operational	November 1, 1997	January 2010
Reports to Congress	March and June annually	March and June annually
Appointing Authority	U.S. Comptroller General (GAO)* Learn about process here.	U.S. Comptroller General (GAO) Learn about process here.
Number of Members	17 (Find current members here)	15 (Find current members here)
Term Length	Three years (terms are staggered)	Three years (terms are staggered)
Public Meetings?	Yes	Yes
Meeting Frequency	8–10 times per year	At least 6 times per year
Key Legislative Influence	MACRA, Medicare Advantage Reforms	Medicaid Drug Pricing, Managed Care Rules

* The term of the current U.S. Comptroller, Gene Dodaro, is set to expire around December 22, 2025. His successor will be appointed by the President with the advice and consent of the Senate.

Conducting Meetings and Developing Reports

MedPAC Meetings and Reporting Process

• Holds 8-10 public meetings per year in Washington, D.C
• Commissioners discuss Medicare payment adequacy, policy trends, and provider reimbursement models
• Staff present research findings, including data analyses, surveys, and policy simulations
• Reports issued twice a year:
  • March Report: Focuses on Medicare payment adequacy and spending projections
  • June Report: Covers broader Medicare policy topics like delivery system reform and beneficiary access
• Recommendations require commissioner approval and are sent to Congress

MACPAC Meetings and Reporting Process

• Holds at least six public meetings per year in Washington, D.C.
• Focuses on Medicaid and CHIP payment models, state policy variations, and financing mechanisms
• Research includes state Medicaid program reviews, economic modeling, and stakeholder input
• Reports to Congress twice annually:
  • March Report: Medicaid and CHIP payment and access issues
  • June Report: Broader Medicaid policy topics, such as managed care oversight
• Commissioners vote on recommendations before inclusion in reports

Influence on Policy and Rulemaking

Both commissions play a critical role in shaping healthcare policy by providing evidence-based recommendations that influence legislative decisions and CMS rulemaking.

MedPAC’s Influence

Key role in Medicare reimbursement reforms, including:

•     MACRA (2015): Shifted physician payment from fee-for-service to value-based models
•     Site-neutral payments: Reforms to hospital outpatient payment structures
•     Bundled payments and alternative payment models (APMs)
•     Influences CMS rulemaking, such as:
  • Medicare Advantage star rating adjustments
  • Updates to inpatient and outpatient hospital payment systems

MACPAC’s Influence

Informs Medicaid financing debates, including:

•     Medicaid Disproportionate Share Hospital (DSH) payment policies
•     State Medicaid waivers (Section 1115 demonstrations)
•     Influences CMS rulemaking in areas such as:
  • Medicaid managed care regulations (2016, 2020 updates)
  • Medicaid drug rebate and prescription drug pricing policies

Comparing Their Policy Impact

Area	MedPAC	MACPAC
Payment Reforms	Physician payment (MACRA), Hospital Payment Models	Medicaid Managed Care, DSH Payments
CMS Regulatory Impact	Medicare Advantage, Post-Acute Care	Medicaid Drug Pricing, Section 1115 Waivers
Legislative Influence	Medicare Trust Fund Sustainability	Medicaid Financing Debates

 

Conclusion

While MedPAC and MACPAC do not have direct regulatory authority, their analyses and recommendations significantly shape healthcare policy for Medicare, Medicaid, and CHIP. Their semiannual reports, public meetings, and independent research help guide Congress and CMS in managing these critical programs. Understanding their roles and influence is essential for policymakers, healthcare executives, and industry stakeholders.