It is probably too big of an ask that you have read the latest MedPAC and MACPAC reports given the demands of managing your business. However, I hope you are at least aware of them and pay attention to the highlights that make the trade press.

Let me give you a background on why they are important to you as a provider and a very brief view of their latest quarterly reports to Congress that were released on June 15^,

-         MedPAC (The Medicare Payment Advisory Commission) is mandated to advise Congress on preserving beneficiaries' access to high-quality care, ensuring efficient and fair provider payments, and controlling Medicare spending growth.

-         MACPAC (the Medicaid and CHIP Payment and Access Commission) is mandated to provide policy and data analysis, and recommend Congress, HHS, and states on issues affecting Medicaid and the State Children's Health Insurance Program.

General

Both commissions are non-partisan/ non-political with 17 members each appointed to staggered, fixed terms so membership changes gradually unrelated to U.S. elections. Members are appointed by the U.S. comptroller general, who heads the Government Accountability Office (GAO). The comptroller general is appointed to a long, fixed term through a bipartisan congressional process.

If you look at the members of both commissions, they are selected based on their expertise rather than a specific partisan affiliation and the executive branch has no approval rights. We need that independence. In many ways this is a who’s who of leaders in healthcare academia, research, providers, advocates, and plans/insurers. The commissions include physicians, hospital and health system executives, economists, researchers, healthcare finance experts, employers, and consumer advocates. It is a prestigious and time-consuming commitment given the normal day job these folks hold. The commissioners don’t do this for the money as there is very little financial return other than travel expense reimbursement and a small daily stipend. A commissioner's annual commitment may include six to eight full-panel meetings, committee work, preparation of meeting materials, conference calls, hearings, and other stuff.

MedPAC

Listen or watch a meeting with morning and afternoon sessions of two to four hours each and you will come away impressed – mentally burned out, too. These folks do their homework and come prepared to offer comments/questions and direct the conversation on the agenda. There are short breaks as the commission staff members take turns running sections of the agenda.

These meeting agendas result in two reports a year with 500-700 pages each broken down by chapter into provider type or issue. They are a “must know” in the policy world. The latest report has chapters on the complexity of beneficiary enrollment decisions as they navigate traditional Medicare and Medicare Advantage (MA) plans, a section on access to hospice and palliative care for beneficiaries with ESRD or cancer, a chapter of the impact of MA on hospital and post-acute care finances/P&Ls, a chapter on provider and plan payment incentives, and my favorite – a detailed analysis of the coverage and payment for ambulance services.

You’ve read about issues with data collection within SNF Medicare Cost Reports. MedPAC faced worse issues in trying to find rational and usable data to figure out the accuracy of ambulance service payment. It’s good reading for a policy wonk like me. Earlier MedPAC reports have had focus on SNF industry interests including dual eligibility, special needs plans, and other topics with which the industry is dealing.

MACPAC

The latest MACPAC report has seven chapters. SNF providers will be interested in their recommendations on the implementation of community engagement requirements (I.e., work requirements for beneficiaries), automation of Medicaid prior authorizations (to avoid service disruptions to beneficiaries), and tools for ensuring accountability of Medicaid managed care plans. Also covered are Medicaid agencies and their role in all-inclusive care for elderly (PACE) individuals, and finally provider enrollment and credentialing in Medicaid. On the Children’s Health Insurance Program (CHIP) side, the chapters are on residential behavioral health treatment, and how to manage the transition of children and youth with special health care needs (CYSHCN) to adult coverage.

Historically, MACPAC's work has informed federal actions related to Medicaid supplemental payments, and disproportionate share hospital (DSH) payments, managed care in Medicaid, and home- and community-based services (HCBS). We should all be interested in future discussions on these topics as Medicaid is the largest payer of services in the industry.

Budgets

Behind the 17 commissioners in each organization lies a relatively small professional staff who try to stay five steps ahead of the curve with an equally small budget.

Research shows that MedPAC is the larger of the two organizations with anywhere between 40–50 full-time staff members while MACPAC has 30-40 FTEs. Annual funding for the commissions ranged from approximately $15–20 million annually for MedPAC to $10–15 million annually for MACPAC, although actual funding levels vary from year to year. Both commissions receive direct congressional appropriations and are not funded through CMS or the Dept. of Health and Human Services. They are considered legislative branch support agencies and run independently of the executive branch. This best serves our providers and residents.

Commission Composition

How do you set up a 17-commissioner panel for each organization to adequately stand for all provider types and plans, clinicians, and most importantly beneficiary needs in the federal and state programs throughout the nation? Carefully, it appears.

I’m a numbers geek, not a researcher, so I asked an AI tool to tell me the percentage of commissioners by background. AI generated the categories. Apologies, that I did not look at the list of commissioner names and assign them to a category. Anyway, I came up with the table below by converting the AI range (low to high range) into a single percentage point for each with the total adding to 100 percent. I then calculated an FTE count for each and made sure it totalled17 commissioners.

Representation of Providers and Beneficiaries

If this representation is right, it shows that providers and health plans make up about 45-55 percent of commissioners or 8-9 individuals (yellow); while consumer and beneficiary advocates (orange) make up only 5-10 percent or 1-2 individuals. While this may be explained by the technical nature of both commissions, as a Medicare beneficiary myself I am concerned about the underrepresentation of beneficiaries or their advocates. I urge readers of this article to look into this further and advocate to members of Congress that future commissioners with experience as consumer and disability advocacy be appointed to balance this allocation more in that direction.

Read the June MedPAC report here June 2026 Report to the Congress: Medicare and the Health Care Delivery System.

And, read the June MACPAC report here June 2026 Report to Congress on Medicaid and CHIP - MACPAC.   

About the Author: Martin Allen is the former senior vice president of reimbursement policy for the American Health Care Association/National Center for Assisted Living. He also served as the vice president of revenue cycle and reimbursement services for ProMedica Senior Care (formerly HCR ManorCare). A certified public accountant with a master’s in business administration, Allen has more than 35 years of extensive work in accounting, Medicare and Medicaid reimbursement, healthcare compliance, risk management, and revenue cycle processes.

Any thoughts on this article? Please contact Patrick Connole at pconnole@parkplacelive.com.