MedPAC & MACPAC: Medicare and Medicaid's Payment Advisors
Summary
Congress's own advisers on Medicare and Medicaid payment policy run on $23.2 million and 69 people combined -- about 7 cents per U.S. resident a year -- and MedPAC's unimplemented recommendations alone would save Medicare hundreds of billions of dollars.
What is this organization?
What does it do?
Each commission delivers two mandated reports to Congress a year, in March and June, plus a running stream of technical work between them. In 2024, MedPAC staff fulfilled more than 250 requests for technical assistance⧉ from congressional staff and submitted 11 comment letters on 's proposed Medicare rules. MACPAC held 6 public meetings averaging 483 registrants each⧉ and published more than 28 reports, issue briefs, and data resources in 2024, including its annual MACStats data book on Medicaid and spending and enrollment.
What does it cost to run — money and people?
MedPAC's fiscal year 2025 appropriation was $13.824 million, funding 35 full-time staff⧉ alongside its 17 part-time commissioners. MACPAC's FY2025 appropriation was $9.405 million, funding 34 full-time staff⧉. Combined, that's $23.2 million and 69 people advising Congress on programs that, by MedPAC's own count, covered more than 65 million Medicare beneficiaries in 2024 alone⧉. Measured against the Census Bureau's 341.8 million U.S. residents⧉, the two commissions together cost about 7 cents per person a year.
View data as table
| MedPAC (Medicare) | 13.8 | 35 FTE + 17 commissioners |
|---|---|---|
| MACPAC (Medicaid & CHIP) | 9.4 | 34 FTE + 17 commissioners |
Why is it good for society?
Both commissions earn their keep by catching what payment formulas miss. MedPAC's unimplemented recommendations alone would save hundreds of billions of dollars⧉ in Medicare spending, and its analysis has fed directly into the Inflation Reduction Act, the 2018 Bipartisan Budget Act, and MACRA. MACPAC's work moves slower but lands: it recommended eliminating CHIP's enrollment waiting periods in 2014 and 2017⧉; finally did so in 2024 -- a decade in which children went without coverage a rule change could have ended sooner.
- Combined, MedPAC and MACPAC cost about 7 cents per U.S. resident a year (FY2025) -- while MedPAC's own unimplemented recommendations would save hundreds of billions in Medicare spending alone.
- MACPAC recommended eliminating 's coverage waiting periods in 2014 and 2017; didn't act until 2024 -- a decade illustrating that these commissions advise, but Congress and decide.
Your handles.* Both commissions take live public comment during their public meetings -- check the MedPAC meeting schedule or MACPAC's public meetings page, each held virtually with public comment built into the agenda. Neither commission takes assignments directly from the public -- new mandated reports come from Congress, so the lever for a new analysis is your own member of Congress.
Sources(5) ▾
- Medicare Payment Advisory Commission (MedPAC), Justification of Appropriation Request for the Committees on Appropriations, Fiscal Year 2026 (2025-06-01) — MedPAC's own congressional budget justification, submitted June 2025 -- the source for this entry's identity/statutory-authority text, FY2025 enacted appropriation and staffing figures, FY2024 workload counts (technical-assistance requests, comment letters), and the 'why is it good for society' mechanism examples (unimplemented-recommendation savings, legislation informed). medpac.gov · original document
- Medicaid and CHIP Payment and Access Commission (MACPAC), Budget Justification: Justification of Appropriations Request for the Committee on Appropriations for Fiscal Year 2026 (2025-06-01) — MACPAC's own congressional budget justification, submitted June 2025 -- the source for this entry's identity/statutory-authority text, FY2025 actual appropriation and budgeted-staffing figures, CY2024 workload counts (meetings, published resources), and the -waiting-periods recommendation-to-adoption example. macpac.gov · original document
- Office of the Law Revision Counsel, U.S. House of Representatives (uscode.house.gov), 42 U.S.C. § 1395b-6 -- Medicare Payment Advisory Commission (2026-07-16) — The official U.S. Code text establishing MedPAC, codifying Section 4022 of the Balanced Budget Act of 1997 -- the source for the exact establishment/membership language quoted in this entry. The available Wayback capture predates this entry (2020); the statutory establishment and membership-composition language it captures is unchanged in the live 2026 page, independently confirmed by direct fetch and cross-checked against the parallel Cornell LII mirror (law.cornell.edu/uscode/text/42/1395b-6). uscode.house.gov · original document
- Office of the Law Revision Counsel, U.S. House of Representatives (uscode.house.gov), 42 U.S.C. § 1396 -- Medicaid and CHIP Payment and Access Commission (2026-07-16) — The official U.S. Code text establishing MACPAC, codifying Section 506 of the Children's Health Insurance Program Reauthorization Act of 2009 (P.L. 111-3), which added Section 1900 to Title XIX of the Social Security Act -- the source for the exact establishment/membership language quoted in this entry. A Wayback save request for this exact query URL returned no snapshot (the site's query-string search interface isn't reliably crawled); the URL above is the direct, one-click official-code link, and its establishment/membership text was independently corroborated against the parallel Cornell LII mirror (law.cornell.edu/uscode/text/42/1396). uscode.house.gov · original document
- U.S. Census Bureau, U.S. Population Growth Slows Due to Historic Decline in Net International Migration (Vintage 2025 national population estimate) (2026-01-27) — The Census Bureau's own Vintage 2025 national population estimate release, giving the U.S. resident population as of July 1, 2025 -- the per-resident denominator for this entry's cost-per-person KPI, per better_metrics.md's sourced-denominator discipline. Same sealed capture already used by good-citizen-gao for the identical primary document. census.gov · original document
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MedPAC and MACPAC are Congress's own advisers on how Medicare and Medicaid pay for care. MedPAC was established in 1997 by Section 4022 of the Balanced Budget Act⧉, which set it up "as an agency of Congress"⧉, composed of 17 members appointed by the Comptroller General. MACPAC followed in 2009, created by Section 1900 of the Social Security Act⧉ with the identical structure -- 17 Comptroller-General-appointed commissioners. Both sit in the legislative branch and answer only to Congress.