MACPAC Recommendations for Pediatric to Adult Health Care Transition”

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The National Commission Makes Medicaid Recommendations to Improve the Transition from Pediatric to Adult Health Care for Children and Youth with Special Health Care Needs: Strategies for Title V Agencies

Prepared by: The National Alliance to Advance Adolescent Health/Got Transition for the National Center for a System of Services for CYSHCN in May 2026

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Summary

The Medicaid and Children's Health Insurance Program Payment and Access Commission (MACPAC), in June 2025, published policy recommendations on pediatric to adult health care transition (HCT) for children and youth with special health care needs (CYSHCN). MACPAC is a non-partisan legislative branch agency that makes recommendations to Congress, the Department of Health and Human Services, and states on issues affecting Medicaid and the Children’s Health Insurance Program (CHIP). Their recommendations call for states to implement, cover, and measure pediatric to adult HCT services and to take advantage of state Medicaid/Title V interagency agreements to specify roles of the agencies in supporting CYSHCN transition.

Receipt of pediatric to adult HCT preparation has been shown to be a critical component of a well-functioning system of services.¹ Yet, according to the 2023-2024 National Survey of Children’s Health (NSCH), only 21% of publicly insured CYSHCN, ages 12-17, receive services from their health care providers to prepare for this transition.²

State Title V programs, together with family-led organizations, are in a unique position to work with state Medicaid agencies and their contracted managed care plans to address the challenges that MACPAC identified, and they can support practical steps to implement the recommendations. Given Title V’s extensive efforts advancing HCT as a national performance measure (NPM) and the lived HCT experience of youth and family partners, this knowledge is vital to share. Title V’s efforts to improve the universal medical-home NPM create a foundational infrastructure to implement effective HCT for CYSHCN.

This resource, intended for state Title V programs and family leaders, includes suggested background information, action steps, and resources that align with each MACPAC recommendation. Please consider the following questions as you develop your strategy:

Which incremental steps would be the most feasible?
Which incremental steps would be the most valuable to start with?
How can pediatric to adult HCT play a role in achieving Medicaid goals (eg, managing chronic conditions, supporting care continuity, reducing emergency department use, and supporting youth and family engagement)?

MACPAC Recommendation #1

All state Medicaid programs should implement a strategy for transition from pediatric to adult care for CYSHCN, including an individualized HCT plan that describes the responsible entity for developing and implementing the plan, the timeframe for developing the plan, and the process for publicly informing about the state’s pediatric to adult HCT strategy and beneficiary resources.

Note for Title V: While a full, state-wide, Medicaid HCT strategy may be a long-term goal, the following steps can help identify potential opportunities that are aligned with states’ managed care contracts (MCCs). Other state Medicaid policy or guidance could represent additional opportunities, such as care coordination contracts.

Background Information You Need

Search online, including the state’s Medicaid agency’s website, for the Medicaid MCCs or Request for Proposals (RFPs) for both general and specialty plans, or request the contracts/RFPs directly from your state’s Medicaid agency. (Note: Specialty plans can be pediatric only, adult only, or combined. All are relevant.)
Review the MCC/RFP to identify pediatric to adult HCT provisions. Search for the word “transition,” knowing that many references to transition are related to hospital-to-home transition or transitions between MCCs. Relevant sections where reference to pediatric to adult HCT may be found include sections on definitions, member services and education, provider network, covered services, care coordination, and quality and evaluation.
Pull your state’s data from the NSCH on the percentage of CYSHCN who receive pediatric to adult HCT preparation from their health care providers. This can be found here or at childhealthdata.org.

Action Steps

Create talking points based on the collected background information, highlighting available pediatric to adult HCT MCC/RFP provisions and noting where there are opportunities to add or expand upon existing HCT provisions.
Contact Medicaid managed care officials to schedule a strategic discussion. Frame the conversation to emphasize how a structured HCT process can help address shared priorities, using the MACPAC findings, this background analysis, and your state’s HCT data from the NSCH. Offer to bring Title V, family-based organizations (such as Family Voices), and other key stakeholders together to support the state in developing a preliminary HCT strategy. Key discussions with Medicaid about HCT may include:
- Improving care continuity and quality (eg, reducing gaps in care and poor outcomes) when CYSHCN age out of pediatric systems
- Aligning HCT strategy with current MCC and/or care coordination requirements, as outlined by MACPAC and professional organizations
- Improving patient/family experience
Identify and propose feasible action steps that the state Medicaid agency might want to consider. Some ideas to consider are:
- If your state has a pediatric to adult HCT strategy for a selected population (eg, youth in foster care or enrolled in a waiver), could those HCT strategies be adapted to strengthen support for CYSHCN, without creating new initiatives?
- As part of existing care coordination program activities within or outside of MCCs, can HCT plan development be added to existing care plan requirements for CYSHCN?
- Gather feedback from your state’s Medicaid Beneficiary Advisory Council.
- In future RFPs, could managed care organizations (MCOs) and care coordination organizations describe the methods they are using for HCT planning, transfer of care, and integration into adult care? As an example, these methods could include creating and sharing individualized pediatric to adult HCT plans with CYSHCN, their families, and adult providers.

Relevant Resources

American Academy of Pediatrics (AAP)/American Academy of Family Physicians (AAFP)/American College of Physicians (ACP) Clinical Report on Health Care Transition (HCT)
Six Core Elements of HCT, including customizable sample tools for pediatric to adult HCT, including transition readiness assessments, HCT plans of care, medical summaries and emergency care plans, and transfer of care checklists
Six Core Elements Implementation Guides
Medicaid Managed Care Contract Language to Expand the Availability of Pediatric to Adult Transitional Care
Family Toolkit on HCT

MACPAC Recommendation #2

Guidance should be issued to states on using existing Medicaid authorities for covering pediatric to adult transition of care services for CYSHCN.

Note for Title V: States are unlikely to have issued specific guidance on coverage for pediatric to adult HCT services, so it may be helpful to specify what HCT services you are referring to (eg, HCT readiness assessment, education and counseling around self-care skills, medical summary, HCT plan of care, communication and consultation between pediatric and adult providers).

Background Information You Need

Determine if your state Medicaid office has issued any provider or billing guidance on existing authorities that can be used to cover HCT services for CYSHCN, including EPSDT, targeted case management, health home services, and various waivers.
Examine your state’s current Medicaid fee schedule to find out what codes related to pediatric to adult HCT-related services are recognized and what the payment rate is for each covered service, keeping in mind that MCOs may pay different rates. For more information, see the 2025 HCT Coding and Payment Resource listed below under Relevant Resources.
Discover if the state has implemented any payment pilots, including value-based payment (VBP) options, to incentivize pediatric and adult providers to deliver recommended HCT services.

Action Steps

Create talking points on the coverage and payment findings from your research, focusing particular attention on the services described above. There are codes that can be used for each of these (see coding and payment resource below).
Contact your AAP Chapter to share your findings and inquire if they would be interested in collaborating on this MACPAC recommendation.
Contact state Medicaid policy officials to share your findings and elicit their interest in introducing pediatric to adult HCT into existing coverage authorities.
Explore interest in pursuing coverage and payment incentives for pediatric to adult HCT.
Offer to provide training around HCT payment, coding, and documentation, focusing on a few key codes (eg, related to HCT plan of care, medical summary, HCT readiness assessment, education and counseling around self-care skill-building, and joint telehealth visits between pediatric and adult providers and beneficiary).

Relevant Resources

MACPAC Recommendation #3

All states should collect and report data on receipt of pediatric to adult HCT services, including an individualized HCT care plan and beneficiary and caregiver experience with pediatric to adult transition of care.

Note for Title V: Few state Medicaid agencies have specified pediatric to adult HCT quality measurements. However, they may have called for these measures for selected populations (eg, foster care).

Background Information You Need

Determine if there are any state Medicaid quality measurement provisions related to pediatric to adult HCT. Sometimes quality requirements are in the MCC/RFP; they may also be on the state Medicaid’s website. Examples of such measures include:
- Structure measures, such as a written description of the HCT approach that MCCs and their participating pediatric and adult providers are to implement; a documented process in their electronic medical record (EMR) for identifying CYSHCN receipt of HCT services, transfer date, and initial adult visit; availability of adult workforce to receive transferring patients.
- Process measures, such as adult provider receipt of a HCT plan of care, exchange of medical summary between pediatric and adult providers and the beneficiary.
- Outcome measures, such as beneficiary/family experience with the HCT process, loss to follow-up among youth and young adults, emergency department visits for ambulatory-sensitive conditions between last pediatric visit and initial adult visit, hospitalizations, and adult clinic utilization.
Check out if the state Medicaid agency and its MCOs are working on performance improvement projects (PIPs) that could pertain to pediatric to adult HCT, such as adolescent preventive care, chronic or complex conditions, or integrated primary and behavioral health care.
Check out if the state Medicaid agency has implemented VBP options for care coordination and identify what measures are called for in relation to plans of care.
Look into whether your state Medicaid agency uses the Consumer Assessment of Healthcare Providers and Systems (CAHPS) to elicit beneficiary experience.

Action Steps

Create talking points on the quality findings from your research.
Contact your state Medicaid pediatric medical director and/or quality officials to share your findings and learn about their interest in piloting selected HCT measures, adding HCT as a new PIP or as an add-on to existing PIP work, or adding HCT questions to CAHPS. Alternatively, consider a brief HCT survey or series of focus groups to gather beneficiary feedback, in close collaboration with the Beneficiary Advisory Committee.
Consider reaching out to an MCO pediatric medical director to ask about their interest in piloting HCT quality measures, including EMR updates aligned with financial incentives.

Relevant Resources

MACPAC Recommendation #4

State Medicaid/Title V interagency agreements should be amended to specify each agency’s role in supporting pediatric to adult HCT for CYSHCN.

Note for Title V: Making changes to state interagency agreements is often time-consuming. In the meantime, there are numerous partnership opportunities to explore with Medicaid that may be more practical over the short term (eg, a working group on HCT) and which would promote shared ownership for HCT success. See Action Step A for possible areas of HCT collaboration between Medicaid and Title V.

Background Information You Need

Obtain your state’s Title V/Medicaid interagency agreement to identify if there is any reference to coordinated pediatric to adult HCT activities. This agreement can be found in Section IV “Title V-Medicaid IAA/MOU” of your state’s latest block grant application/annual report on the TVIS MCHB website.
Determine what the process and timing is for potentially updating the interagency agreement. Identify other mechanisms that might be available to partner on HCT.
Based on what is learned from working on the above Recommendations 1-3, it may be evident what collaborative roles will make best sense going forward.

Action Steps

Consider and prioritize various collaborative roles between Medicaid and Title V related to pediatric to adult HCT as a key component of the state system of care for CYSHCN. These may include:
- Education, training, and referrals of MCOs and care coordination organizations related to transition from pediatric to adult care
- Access assistance to Medicaid, CHIP, and marketplace coverage application, renewal, and beneficiary information
- Development of HCT performance measurement and quality/performance improvement projects on HCT
- Review of HCT coverage authorities, including targeted case management, EPSDT, health homes, waivers
- Participation in interagency HCT workgroup
- Sharing HCT resources on Medicaid’s website from the state Title V agency and Got Transition
- Participation in managed care contract reviews and site reviews related to HCT
- Development of incentives for collaborative pediatric and adult HCT program efforts

Relevant Resources

In 2024, the Maternal and Child Health Bureau awarded a 5-year grant to Altarum to lead a center for maternal and child health Medicaid partnerships. This work includes supporting improvements in Medicaid/Title V interagency agreements. For more information, visit www.altarum.org.
Leverage Opportunities + Speak the Medicaid Language: A Workbook for Title V (Catalyst Center)
State Strategies to Leverage Medicaid and Title V Programs to Improve Care for Children With Special Health Care Needs in Medicaid Managed Care (NASHP)
Collaborations Between State Title V Maternal and Child Health Programs and Medicaid (AMCHP)
Medicaid and Title V: Considerations When Braiding Funds (Center for Maternal and Child Health Medicaid Partnerships)
AAP Chapter Websites

References

Ilango SM, Lebrun-Harris LA, Jones JR, McManus MA, Cyr M, Mann MY, McLellan SB, White PH. Associations between health care transition preparation among youth in the US and other components of a well-functioning system of services. Journal of Adolescent Health. 2021;69(3):414-23.
Child and Adolescent Health Measurement Initiative. 2023-2024 National Survey of Children’s Health (NSCH) data query. Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Accessed January 1, 2026. www.childhealthdata.org.

Acknowledgements

The Got Transition team thanks the great feedback received on this brief from the AAP National Center for a System of Services for CYSHCN team, Meg Comeau and Allyson Baughman from the Center for Innovation in Social Work and Health at Boston University School of Social Work, Heather Smith from the National Academy for State Health Policy, Allysa Ware from Family Voices, and Marcus Allen, Michelle Burgher, Alison J. Martin, and Quondalynn Rainey from state Title V CYSHCN programs.

The National Center for a System of Services for CYSHCN is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $1,500,000 with no funding from nongovernmental sources. The information or content are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.

Contact Information

For more information, email [email protected] or visit the websites of the National Center for a System of Services for Children and Youth with Special Health Care Needs and Got Transition.

Last Updated

05/19/2026

Source

American Academy of Pediatrics

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