What the March 2026 MACPAC Report Means for Medicaid and CHIP Families

Why this report matters right now

Medicaid and the Children’s Health Insurance Program (CHIP) cover tens of millions of people in the United States, including the majority of children in low-income families. After the end of the COVID-19 “continuous coverage” policy, states resumed regular eligibility checks—a process often called the “unwinding.” That shift led to major changes in enrollment.

In March 2026, the Medicaid and CHIP Payment and Access Commission (MACPAC) released its annual Report to Congress, reviewing how Medicaid and CHIP are functioning after that transition. The report does not change the law. But it helps lawmakers understand what is working, where problems remain, and what policy options may be under consideration.

For families who rely on Medicaid or CHIP, the key questions are practical: Is coverage stable? Can people find doctors who accept Medicaid? And are states financially positioned to maintain access to care?

What MACPAC does — and what it does not do

MACPAC is a nonpartisan federal advisory body. It studies Medicaid and CHIP and makes recommendations to Congress. It does not set benefits, cut funding, or change eligibility rules on its own. Those decisions are made by Congress, the Centers for Medicare & Medicaid Services (CMS), and state governments.

The March 2026 report focuses on four broad areas:

Enrollment trends after the unwinding
Access to primary, specialty, and behavioral health care
Oversight of Medicaid managed care plans
Federal–state financing pressures

Some sections describe current conditions. Others offer policy recommendations that Congress or CMS could consider—but none are automatically in effect.

Enrollment after the unwinding: What the new data show

According to national enrollment data from CMS, Medicaid and CHIP enrollment declined after states resumed eligibility redeterminations following the end of the public health emergency protections. During the pandemic, states were required to keep most people continuously enrolled. Once that requirement ended, millions of people were reassessed for eligibility.

CMS enrollment data show that total enrollment has fallen from its pandemic peak, with variation across states. Some individuals lost coverage because they were no longer eligible due to income changes. Others were disenrolled for procedural reasons—such as not returning paperwork—even though they may still have qualified.

MACPAC highlights that children remain a central focus. Medicaid and CHIP together cover a large share of children nationwide. The report notes ongoing concerns that eligible children may lose coverage because of administrative barriers rather than true ineligibility. Coverage stability for children is closely linked to preventive care, including well-child visits, immunizations, dental care, and developmental screenings.

The report also underscores that enrollment trends differ by state. Policy choices—such as how states conduct renewals, whether they use automatic (“ex parte”) renewals based on existing data, and how they communicate with families—have influenced how smoothly the unwinding occurred.

Access to care: Coverage is not the same as access

Having Medicaid coverage does not automatically guarantee timely access to care. MACPAC’s March 2026 report reviews ongoing challenges in several areas:

Primary care

In many communities, especially rural areas, provider participation remains uneven. Some clinicians limit the number of Medicaid patients they accept due to reimbursement rates or administrative requirements. When fewer providers participate, patients may face longer wait times or travel farther for appointments.

Specialty care

Access to specialists—such as cardiologists, neurologists, or pediatric subspecialists—continues to vary widely by state and region. MACPAC notes that measuring specialty access is complex, in part because provider directories may not always reflect real-time availability.

Behavioral health

Behavioral health services, including mental health and substance use treatment, remain an area of high need. Workforce shortages and uneven integration between physical and behavioral health services can limit timely care. These challenges affect both adults and children.

Oral health

For children in particular, Medicaid is a major source of dental coverage. However, dentist participation varies by state. When fewer dental providers participate, children may experience delays in preventive services such as cleanings and sealants, which are linked to overall health and school attendance.

MACPAC emphasizes that improving access requires not only coverage stability but also strong oversight of managed care plans and accurate monitoring of provider networks.

Managed care oversight: What was flagged

Most Medicaid enrollees receive care through managed care organizations (MCOs)—private plans that contract with states. MACPAC’s report reviews how states and CMS oversee these plans.

Key oversight issues include:

Network adequacy: Are there enough primary care providers, specialists, and behavioral health clinicians in plan networks?
Payment transparency: How clearly do states track how federal and state dollars flow to plans and ultimately to providers?
Quality monitoring: Are states using reliable data to measure access, outcomes, and patient experience?

MACPAC does not conclude that managed care is failing. Instead, it highlights areas where clearer data, stronger monitoring, and better alignment between payment and performance could improve accountability. Any changes to oversight would require regulatory or legislative action by CMS or Congress.

Financing pressures: Federal–state realities

Medicaid is jointly financed by states and the federal government. The federal share—known as the Federal Medical Assistance Percentage (FMAP)—varies by state based on income levels. CHIP has a separate enhanced federal match rate.

During the pandemic, states received temporary increases in federal matching funds. As those enhancements phased out, states resumed a larger share of program costs. At the same time, some states face broader budget pressures from inflation, workforce shortages, and rising healthcare costs.

MACPAC’s report reviews how financing structures influence state decision-making. It does not announce funding reductions or benefit cuts. However, it notes that states must balance budgets annually, which can shape debates about provider rates, eligibility processes, and delivery system reforms.

Independent analysis from KFF has similarly documented how post-unwinding enrollment shifts and expiring federal support have created different fiscal conditions across states.

Who may be most affected

The groups most sensitive to enrollment and access changes include:

Children, particularly those in low-income working families
Low-income parents and adults in Medicaid expansion states
People with disabilities, who may rely on specialized services and long-term supports
Rural communities, where provider shortages are more common

For these groups, small administrative barriers—such as missed renewal notices—can interrupt coverage, even if eligibility remains unchanged.

What is still uncertain

MACPAC’s March 2026 report outlines trends and policy options. What happens next depends on Congress, CMS rulemaking, and state-level decisions. Some recommendations may be debated; others may inform future regulations or legislative proposals.

Enrollment trends will continue to evolve as states refine renewal processes and as economic conditions change. Access improvements may depend on workforce growth, payment policies, and continued oversight of managed care networks.

Practical guidance for families

If you or your child is enrolled in Medicaid or CHIP:

Make sure your state Medicaid agency has your current address, phone number, and email.
Open and respond promptly to renewal notices.
Use your state’s official Medicaid website or customer service line for coverage questions.
If coverage is terminated and you believe you are still eligible, ask about appeal rights or reapplication options.

Medicaid and CHIP remain the backbone of coverage for millions of families. The March 2026 MACPAC report makes clear that coverage stability, provider participation, and financing structures all matter—not just enrollment totals.

For families, the most important takeaway is practical: stay engaged with renewal notices, know your rights, and use official state channels for accurate information. Policy debates will continue, but day-to-day coverage stability often depends on timely paperwork and up-to-date contact information.

Sources

This article is for general informational purposes only and is not medical advice. Research findings can be early, limited, or subject to change as new evidence emerges. For personal guidance, diagnosis, or treatment, consult a licensed clinician. For current outbreak or public health guidance, follow your local health department, the CDC, or another relevant public health authority.