In early 2023, Massachusetts began implementing its Roadmap for Behavioral Health Reform (Roadmap), a sweeping set of changes aimed at simplifying access and entry to the state’s outpatient behavioral health care system for all Massachusetts residents. The Roadmap reforms are designed to address challenges with the current behavioral health care system, including difficulty finding community-based providers and culturally relevant services, a lack of integrated mental health and addiction treatment, and a continued reliance on the emergency department for crisis and acute care.

Last month the Foundation released a report describing the key components of the Roadmap and how they are intended to improve access to behavioral health care services. It also provided an update on Roadmap implementation, described early successes and challenges, and identified opportunities to strengthen implementation moving forward.

As a follow on to the release of this report, the Foundation hosted a webinar with the report's authors from Manatt Health on Wednesday, September 11, 2024, from 1-2 PM. The webinar provided an overview of the Roadmap and key takeaways from the report.

Click here to view a recording of the webinar.

In 2013, Massachusetts launched One Care, an integrated care program that serves dual eligible individuals with disabilities age 21 to 64 (at the time of enrollment). One Care aims to coordinate Medicare and Medicaid benefits, streamline services and financing through a single health plan, and help its members live independently and thrive in the community. The program serves around 42,000 dual eligible members in Massachusetts.

The federal authority under which One Care has operated is ending as of December 31, 2025. The Commonwealth will need to transition the program to a new authority. While the One Care program itself will remain, operating it under a new authority with different rules and structures means there will be some program changes. However, Massachusetts has designed a plan to preserve the care model and benefits of One Care, and adopted alternative approaches to providing as integrated an experience for members as possible.

The purpose of this report is to provide background on the One Care program as it exists today and to educate policymakers, advocates, and other stakeholders of One Care’s upcoming transition to a new federal authority. 

The Blue Cross Blue Shield of Massachusetts Foundation released a report today offering an early examination of the state’s implementation of the Roadmap for Behavioral Health Reform (the Roadmap), a sweeping set of changes aimed at improving access to the outpatient mental health and substance use disorder treatment system for all Massachusetts residents.  Researchers found both successes and challenges since the Roadmap’s launch in early 2023, and identified opportunities to strengthen the multiyear strategy to close critical gaps in community-based care.

The Blue Cross Blue Shield of Massachusetts Foundation released a report today offering an early examination of the state’s implementation of the Roadmap for Behavioral Health Reform (the Roadmap), a sweeping set of changes aimed at improving access to the outpatient mental health and substance use disorder treatment system for all Massachusetts residents.  Researchers found both successes and challenges since the Roadmap’s launch in early 2023, and identified opportunities to strengthen the multiyear strategy to close critical gaps in community-based care.

The report highlights last year’s rollout of the statewide Behavioral Health Help Line, providing 24/7 access to individuals and families seeking crisis and other services, along with the opening of 27 Community Behavioral Health Centers (CBHCs) to serve as “one-stop locations” for treatment across the state.  A third major component of the Roadmap, community-based Behavioral Health Urgent Care sites providing same-day or next-day outpatient appointments, is also reviewed.  The report, prepared by research partner Manatt Health, is based on input from key stakeholders and early implementation data.

Other components of the Roadmap are still getting under way. These include improving integration of behavioral health and primary care - incentivized through new payment models - and improving people's experience in accessing community-based behavioral health care services, particularly for acute and crisis care, to help reduce unnecessary visits to hospital Emergency Departments.

“This report shows improvement in access to community-based behavioral health care as a result of the implementation of the Roadmap, and that is a major step forward given the barriers to care that have existed for so long,” said Audrey Shelto, President and CEO of the Blue Cross Blue Shield of Massachusetts Foundation. “There is broad support for the state’s progress and commitment to the Roadmap, and a recognition of the need for more active stakeholder engagement and public education about these reforms moving forward.”

Stakeholders interviewed for the report – including providers, advocates, state government officials and others – acknowledged initial successes while also identifying some early implementation challenges.  For instance, variability in network coverage and payment across different insurance carriers has created difficulties for some individuals in accessing and receiving timely care. Additionally, uncertainty about the role of ambulance providers and law enforcement in transporting individuals in crisis to CBHCs may be limiting access to these essential services, preventing those in need from receiving care in the most effective and seamless manner. 

“This Roadmap is a brand-new approach and, as with any pioneering initiative, the need for monitoring, feedback, adjustments and refinements is a key part of its rollout,” said Kaitlyn Kenney Walsh, Vice President of Policy and Research at Blue Cross Blue Shield of Massachusetts Foundation.  “With proactive coordination across stakeholders, the solutions described in this report can help address early implementation challenges and sustain and enhance this critical behavioral health initiative.”

The report outlined opportunities for improvements to the Roadmap implementation and broader system reforms that are crucial to its long-term success:

Specific Improvements to Roadmap Implementation

• Improve coordination among state agencies to enhance cross-agency collaboration, ensuring cohesive policy guidance.
• Expand and clarify coverage for services across different insurance plans to ensure broad access.
• Address transportation challenges related to ambulance and law enforcement dropoffs at CBHCs.
• Enhance stakeholder engagement and develop a public awareness campaign to promote key aspects of behavioral health reforms.

Broader System Reforms Required

• Strengthen and diversify the behavioral health workforce through training programs and payment reforms.
• Advance data sharing and interoperability by adopting electronic health records and other technology platforms.
• Support community-driven solutions to promote equitable access to behavioral health care services, particularly in marginalized communities.

The report, titled Massachusetts Roadmap for Behavioral Health Reform: Overview and Implementation Update, is available online at the following link: https://www.bluecrossmafoundation.org/publication/massachusetts-roadmap-behavioral-health-reform-overview-and-implementation-update

About the Blue Cross Blue Shield of Massachusetts Foundation

The mission of the Blue Cross Blue Shield of Massachusetts Foundation is to ensure equitable access to health care for all those in the Commonwealth who are economically, racially, culturally or socially marginalized.  The Foundation was established in 2001 with an initial endowment from Blue Cross Blue Shield of Massachusetts.  It operates separately from the company and is governed by its own Board of Directors.  For more information, visit www.bluecrossmafoundation.org.

In early 2023, Massachusetts began implementing its Roadmap for Behavioral Health Reform (Roadmap), a sweeping set of changes aimed at simplifying access and entry to the state’s outpatient behavioral health care system for all Massachusetts residents. The Roadmap reforms are designed to address challenges with the current behavioral health care system, including difficulty finding community-based providers and culturally relevant services, a lack of integrated mental health and addiction treatment, and a continued reliance on the emergency department for crisis and acute care.

Based on input from select Massachusetts stakeholders and early implementation data, this report describes the key components of the Roadmap and how they are intended to improve access to behavioral health care services. It also provides an update on implementation of the Roadmap, describes early successes and challenges, and identifies opportunities to strengthen implementation moving forward. 

The Blue Cross Blue Shield of Massachusetts Foundation today announced $360,000 in new grant funding to support 12 organizations working to improve perinatal health across the Commonwealth, including supporting access to doula care for pregnant people in communities of color.

The Blue Cross Blue Shield of Massachusetts Foundation today announced $360,000 in new grant funding to support 12 organizations working to improve perinatal health across the Commonwealth, including supporting access to doula care for pregnant people in communities of color.

The Perinatal Health Initiative grant program is part of the Foundation’s broader strategy of grantmaking and policy analysis aimed at better understanding and disrupting structural racism and eliminating racial inequities in health.

The Foundation’s grantmaking team met with over 30 community organizations and leaders working in perinatal health to inform the design of the Perinatal Health Initiative.  Several grant partners are focused on the doula workforce, which is comprised of trained, non-medical professionals who support people during and after pregnancy.  MassHealth recently began covering their services to improve maternal health and reduce health disparities affecting communities of color.

“This new grant program will expand the capacity of community organizations leading local perinatal health efforts to improve health outcomes,” said Audrey Shelto, President and CEO of the Blue Cross Blue Shield of Massachusetts Foundation.  “Over the next year, these projects will provide education and supports, further develop doula and other perinatal services in key communities, and advance statewide policy and advocacy that will make perinatal health more equitable.”

The Foundation’s Board of Directors approved one-year grants, ranging from $20,000 to $50,000, to each of the following nonprofit organizations and their projects:

• Family Nurturing Center of Massachusetts, which will support newly arrived Haitian migrant families with babies and young children living in emergency shelters in Boston, connecting them to vital resources such as well-child visits, diapers, playgroups and developmental screenings.
• First Teacher Boston, which will provide perinatal health education to Black and Brown families in Dorchester and Roxbury with a series of small-group workshops and a prenatal/postpartum resource toolkit.
• Propa City Community Outreach, which will provide its services focused on perinatal health education and peer support to Boston’s communities of color who are dealing with pregnancy loss.
• Perinatal Wellness Support Center of the Cape & Islands, to provide its six-week training offered in English, Spanish and Portuguese that covers childbirth education, perinatal mood and anxiety disorders, breastfeeding, nutrition and other prenatal and postpartum health issues.
• Sacred Birthing Village, which will expand its multilingual perinatal education program in Greater New Bedford, provided by community volunteers to individuals through their pregnancy and one year following birth. 
• Birth Equity & Justice Massachusetts, which will continue to bring the birth equity community together and be a voice on perinatal policy and advocacy, including efforts to support recent migrants in Massachusetts.
• Family Health Center of Worcester, to support its ''OB Advocate'' program that provides an advocacate, who is trained as a doula, to a patient from pregnancy to two years following birth.
• Massachusetts PPD Fund, which will be able to expand its perinatal mental health training series and raise awareness about perinatal mood and anxiety disorders, a pregnancy complication affecting 1 in 5 new mothers.
• Tufts University’s Center for Black Maternal Health & Reproductive Justice, which will create a digital toolkit to assist doulas with the MassHealth enrollment process and improve access to doula services for Black and Brown pregnant people.
• Berkshire Nursing Families, in support of the next phase of its partnership with Springfield Family Doulas to train and mentor black doulas and lactation counselors in Berkshire County.
• Mass Law Reform Institute, and the Massachusetts Doula Coalition to deepen its capacity for ongoing policy and advocacy efforts as the statewide doula provider community navigates the new MassHealth coverage benefit.
• Neighborhood Birth Center, which will expand its policy capacity by having staff represent the broader birth center and provider community in Greater Boston, including doulas, midwives, and nurse midwives.

“The Foundation’s commitment to funding community-based organizations working in maternal and perinatal health is invaluable,” said Jallicia Jolly, co-chair of Birth Equity & Justice Massachusetts.  Added BEJMA co-chair Yaminah Romulus: “We are truly appreciative of this investment in building our capacity to develop our perinatal health advocacy and coalition-building work while bringing together birth equity communities.”

The Foundation has also been collaborating with other foundations working in perinatal health, and this group of funders has agreed to host a statewide convening focused on birth equity in the future.

The Foundation’s Board also has approved approximately $758,000 in funding for its Strengthening the Voice for Access grant program, which supports statewide advocacy organizations focused on expanding access to health care, increasing collaboration and participation in public policy development, and promoting the interests of people who are marginalized.  This grant program has existed since the Foundation’s inception in 2001 and plays a critical role in advancing its mission.

The following organizations received grants:

• Boston Center for Independent Living
• Disability Policy Consortium
• Health Care For All
• Health Law Advocates
• Massachusetts Association for Mental Health
• Massachusetts Immigrant and Refugee Advocacy Coalition
• Massachusetts Law Reform Institute
• Massachusetts League of Community Health Centers
• Massachusetts Organization for Addiction Recovery
• Massachusetts Public Health Association
• Massachusetts Senior Action Council

About the Blue Cross Blue Shield of Massachusetts Foundation

The mission of the Blue Cross Blue Shield of Massachusetts Foundation is to ensure equitable access to health care for all those in the Commonwealth who are economically, racially, culturally or socially marginalized. The Foundation was established in 2001 with an initial endowment from Blue Cross Blue Shield of Massachusetts. It operates separately from the company and is governed by its own Board of Directors.  For more information, visit www.bluecrossmafoundation.org.

Recognizing that member input is essential for effectively improving health outcomes and advancing equity, MassHealth and other Medicaid agencies across the country are increasingly engaging with members to inform program and policy design. MassHealth currently employs a variety of approaches for soliciting member feedback on program design and policy changes, and has signaled its commitment to strengthening its member engagement approach.

This report aims to inform MassHealth’s efforts to strengthen its overall member engagement strategy. The report:

1. Outlines a framework for understanding different strategies along a continuum of community involvement for engaging with individuals with lived experience.
2. Summarizes MassHealth’s current approach to engaging with members.
3. Describes a set of guiding principles for building a meaningful statewide Medicaid member engagement strategy.
4. Introduces a series of recommendations for building and strengthening MassHealth’s current member engagement strategy.

This is the first of two reports in a series on member engagement. The second report, which takes a deeper look at one specific member engagement tool – Community Advisory Boards (CABs) – will be released this summer.

Long term services and supports (LTSS) are the critical services and supports that people with disabilities and people of all ages with chronic conditions of use to meet their daily living needs, remain independent, and participate in their communities. Last month the Foundation released a primer intended to help stakeholders better understand LTSS in Massachusetts: what these services are, who uses them, and how they are delivered and paid for. As a follow on to the release of this resource, the Foundation hosted a webinar with the primer’s authors from Manatt Health on Monday, June 10, 2024, from 12-1 PM. The webinar focused on a review of key facts and data on LTSS payers, utilization and spending, workforce, and quality in Massachusetts.

Click here to view a recording of the webinar.

As a program that provides publicly funded health benefits to more than 2 million low-income children and families, seniors, and people living with disabilities in Massachusetts, it is not surprising that MassHealth accounts for a large share of the state’s budget. However, a cursory review of the MassHealth budget can be misleading because it can obscure the billions of dollars in federal revenue that the program generates for the state. This brief looks beyond the budget totals to help stakeholders better understand the actual state cost of MassHealth by accounting for the state and federal partnership that finances this program.

In state fiscal year (SFY) 2025, the state projects it will spend approximately $20.3 billion on MassHealth. This total (or “gross” amount) is approximately 31 percent of total estimated state spending for SFY 2025. However, because the federal government reimburses Massachusetts for more than half of its MassHealth spending, the state’s actual cost for MassHealth (“net of”—or minus—federal revenue) is $10.2 billion or 20 percent of the total net state spending in SFY 2025. Fully understanding the actual state cost of MassHealth requires appreciating the details of the federal and other revenue sources that support this essential and comprehensive program.

The Blue Cross Blue Shield of Massachusetts Foundation today announced $250,000 in grant funding to support five community-based projects with strong potential to be scaled to improve access to care while advancing healthy equity.

The Blue Cross Blue Shield of Massachusetts Foundation today announced $250,000 in grant funding to support five community-based projects with strong potential to be scaled to improve access to care while advancing healthy equity.

In addition to funding its major grantmaking programs, the Foundation regularly awards Special Initiatives grants that respond to needs identified by grantees and their communities. The projects aim to positively impact health or health care access for Massachusetts residents who have been economically, socially, culturally or racially marginalized.

The Board of Directors recently approved one-year, $50,000 grants to each of the following nonprofit organizations and their projects:

Community Servings, based in Jamaica Plain, will pilot a “step-down program” for clients who have received medically tailored meals but have become well enough to transition away from home-delivery service. The program will provide a pathway to address food and nutrition insecurity.

The step-down program, starting with 75 individuals, will provide medically tailored food boxes, a cookbook with simple recipes, cooking demonstration videos, nutrition education, and support from a registered dietitian nutritionist. Community Servings plans to expand this Food is Medicine intervention to as many as 500 clients annually with support from health care contracts and philanthropy.

Luminosity Behavioral Health Services, located in Brockton, will develop a more responsive behavioral health model in communities of color throughout southeastern Massachusetts. As the co-convenor and fiscal agent for the South East Multicultural Providers Association (SEMPA), Luminosity and its collaborative partners are aiming to end the “scavenger hunt” for supportive, culturally sensitive therapeutic interventions that exist in the region.

SEMPA members will implement cross-agency agreements to address the availability of services, youth advocacy and referrals. The goal is to train and certify 60 staff members in applying trauma-specific interventions, create a standardized referral process and policies to reduce long waitlists across the participating organizations, and increase the pool of multicultural health professionals and youth mentors serving the needs of Brockton families.

Martha’s Vineyard Community Services, based in Oak Bluffs, will create a co-responder pilot program to address the lack of behavioral health care access for island residents, who typically engage with mental health and substance use services only through 911 calls to police. There is often an inequity in accessing services by racial and ethnic communities for various reasons, including stigma.

The new program would link a qualified behavioral health clinician with local law enforcement to create a pathway to community-based services, diverting residents from detainment, arrest or transport to the hospital emergency department. The organization plans to train up to 10 clinicians, develop an emergency response schedule with law enforcement, and embed clinicians in the island’s six towns.

Prisoners’ Legal Services, a statewide organization headquartered in Boston, will develop a project to increase access to medical parole by creating an infrastructure for pro bono attorneys and medical advocates to collaborate on prisoner petitions. Prisons are not equipped to handle the health care needs of seriously ill or dying prisoners, and medical parole is seen as the best alternative.

Since medical parole became possible in 2018, less than 12% of the 587 petitions have been granted – leaving individuals to die or languish in prison even though their health needs could be met in the community with far less burden on the public. To increase support for eligible incarcerated individuals, the nonprofit will identify and train pro bono attorneys who can respond to referrals, forge connections between the attorneys and pro bono medical providers, and develop resource materials and communications to family members.

Walker Inc., headquartered in Needham, will conduct a feasibility study for a therapeutic preschool model and develop an effective intervention for the growing number of preschool-age children with challenging behaviors who are at risk of suspension or expulsion from early education and care programs in the Dorchester, Jamaica Plain and Roxbury neighborhoods of Boston.

Preschoolers are suspended and expelled at three times the rate of children in grades K-12, according to the U.S. Department of Education. Black children make up a disproportionate number, and preschool-age boys are much more likely than girls to be removed from school. Research shows this can adversely influence developmental, health and education outcomes. Walker Inc. will research the issue, outline a sustainable funding model, and prepare to launch a pilot preschool program.

“These five projects demonstrate novel approaches by community-based organizations aimed at solving a number of systemic challenges that limit health care access,” said Audrey Shelto, President and CEO of the Blue Cross Blue Shield of Massachusetts Foundation. “Our grantmaking team looks forward to supporting their progress and helping them achieve significant outcomes that improve health equity and eventually reach well beyond the initial scope of the pilot and research phases.”

About the Blue Cross Blue Shield of Massachusetts Foundation

The mission of the Blue Cross Blue Shield of Massachusetts Foundation is to ensure equitable access to health care for all those in the Commonwealth who are economically, racially, culturally or socially marginalized. The Foundation was established in 2001 with an initial endowment from Blue Cross Blue Shield of Massachusetts. It operates separately from the company and is governed by its own Board of Directors. For more information, visit www.bluecrossmafoundation.org.