MACPAC ties HCBS shortages to Medicaid pay

MACPAC’s draft content for its upcoming March 2026 Report to Congress places Home and Community-Based Services (HCBS) workforce shortages and Medicaid payment strategy at the center of national policy discussion. The draft, published in January 2026 by the Medicaid and CHIP Payment and Access Commission (MACPAC), draws on state interviews, federal and state data, and expert testimony.

The chapter focuses on how Medicaid payment structures influence recruitment and retention challenges across HCBS programs. In doing so, it frames workforce stability as closely connected to how Medicaid finances and pays for services.

Workforce shortages framed as a financing issue 

A central theme in the draft is that inadequate reimbursement rates are a principal barrier to workforce stability in many states. The draft links insufficient rates to persistent vacancies, high turnover, and service access gaps, positioning reimbursement as a key driver of workforce conditions rather than a secondary operational factor.

This approach reflects an emerging federal narrative: workforce instability is not only a provider-facing staffing challenge, but also a Medicaid payment and financing issue that can shape access to services.

Why MACPAC’s positioning matters 

MACPAC does not directly set payment rates. However, its reports frequently influence congressional discussions, federal guidance, and state Medicaid rate-setting strategies. By placing HCBS workforce shortages and Medicaid payment strategy at the center of its draft chapter, MACPAC elevates the topic within national policy conversation.

Framing workforce shortages as a Medicaid financing issue also signals potential policy momentum toward rate adequacy reviews and payment reform. In practical terms, the draft’s emphasis may shift how stakeholders discuss and evaluate workforce problems, moving the issue from an operational provider concern to a structural Medicaid funding challenge that may drive future federal and state policy shifts.

What agency leadership can take from the draft 

For agency leadership, the draft chapter’s framing provides a clear lane for aligning provider messaging with emerging federal policy trends. Agency leaders should incorporate MACPAC’s workforce framing into rate advocacy efforts with state Medicaid agencies and managed care organizations, particularly by linking workforce shortages directly to reimbursement levels.

The draft also underscores the value of provider-side documentation. Providers should prepare data connecting Medicaid rates to turnover, vacancy rates, overtime costs, and service disruptions. Monitoring the final March 2026 Report to Congress release will be critical for identifying actionable recommendations that may influence state-level rate discussions.