Problem Management Plus (PM+) is a proven, scalable, and cost-effective low-intensity mental health intervention that can be delivered by trained non-clinical workers for people who are experiencing common mental health conditions, such as anxiety or depression, or stressful life problems. PM+ fills a gap in the behavioral health services system by providing early intervention and potential prevention of more acute behavioral health service needs. As a model that relies on building the capacity and diversity of the behavioral health workforce, it holds promise for enhancing access to community-based mental health supports.

This issue brief is designed to define and describe the PM+ intervention and its origins and identify preliminary considerations for implementing it in the United States. Together with the Foundation’s Advancing Community-Driven Mental Health (ACDMH) grant program, this report advances the Foundation’s strategy to test and disseminate models of care that increase access to behavioral health services and expand capacity of the behavioral health workforce. Through ACDMH, the Foundation is providing support to community-based organizations to adapt and implement the PM+ intervention with the aim of expanding access to culturally appropriate low-intensity mental health supports among racially, economically, culturally, and socially marginalized communities.

Massachusetts has been exemplary in developing health insurance coverage policies to cover its residents. By 2019, the state’s uninsurance rate was 3.0 percent, the lowest rate in the nation, representing about 204,000 uninsured residents. While the state’s overall uninsured rate at a given point in time is low, more than twice as many people - 503,000, or 7.3 percent of the population - experienced a gap in coverage over the previous twelve months. And importantly, not all groups benefit equally. People who are Black or Hispanic, or who have lower incomes, experience significantly higher rates of uninsurance than the state population overall. As a result, these groups are more likely to face access barriers and financial insecurity associated with being uninsured.

The purpose of this report is to begin charting a course toward closing the coverage gaps in Massachusetts, with a particular focus on creating a more racially and ethnically equitable system of coverage. The report and accompanying infographics describe the people in Massachusetts without health insurance and the barriers to coverage they face, including affordability, administrative complexity, and immigration, language, and cultural barriers. It then proposes a menu of policy options that address the specific circumstances in Massachusetts. The proposed options are meant to inform a statewide conversation about the best approaches to closing the remaining coverage gaps in Massachusetts and removing structural barriers that result in racial and ethnic disparities in health insurance coverage.

Behind the Data: Voices of the Uninsured
The Foundation recently released a 3-minute video featuring four Massachusetts residents who describe their experiences without health insurance. The video is also available with English subtitles and Spanish subtitles (con subtitulos en Español).

Click here to view

This issue brief aims to educate stakeholders and policymakers about an upcoming federal policy change that could impact coverage for many MassHealth members. Like all states, Massachusetts received enhanced federal Medicaid funding under the Families First Coronavirus Response Act (FFCRA), the first major federal stimulus package passed by Congress in response to the COVID-19 crisis in 2020. As a condition of receiving these funds, Massachusetts was required to maintain continuous coverage in MassHealth during the federal COVID-19 public health emergency. In December 2022, Congress passed the Consolidated Appropriations Act, 2023 which established March 31, 2023 as the end date of the continuous coverage requirement.

Since the federal continuous coverage requirement will expire at the end of March, MassHealth is preparing to redetermine eligibility for all members starting April 1, 2023. As MassHealth begins to redetermine eligibility for a considerable volume of members, there is a risk that some individuals who remain eligible for coverage could become uninsured. This issue brief includes a summary of MassHealth’s eligibility and enrollment approach for when it resumes normal eligibility and redetermination processes and describes strategies that MassHealth and other stakeholders are taking to ensure that people who remain eligible stay covered.

MassHealth provides health care services to over 2 million Massachusetts residents. This infographic highlights key facts about MassHealth, including the many ways in which the program contributes to the Massachusetts economy and promotes health care coverage and access for residents in the state.

The Blue Cross Blue Shield of Massachusetts Foundation today announced that thirteen health and science journalists from across the nation have been selected for the 2023 class of the Health Coverage Fellowship.

The 2023 fellows are Jessica Bartlett of the Boston Globe, Selena Simmons-Duffin of NPR, Sara Willa Ernst of Houston Public Media, Sruthi Gopalakrishnan of the Concord (NH) Monitor, Mark Herz of Boston’s GBH, Keren Landman of Vox, Deidre McPhillips of CNN, Alaa Mostafa of PRX’s This American Life, David Ovalle of the Washington Post, Emily Wagster Pettus of the Associated Press in Mississippi, Laura Santhanam of  PBS NewsHour, Sujata Srinivasan of WNPR in Connecticut, and Sarah Toy of the Wall Street Journal.

The fellowship is designed to help the media improve its coverage of critical health care issues. It does that by bringing in as speakers more than 75 health officials, practitioners, researchers, and patients. It also brings the journalists out to watch first-hand how the system works, from walking the streets at night with mental health case workers to visiting the world’s biggest brain bank.

The program, which is entering its twenty-second year, is sponsored by the Blue Cross Blue Shield of Massachusetts Foundation, with support from the Bower Foundation in Mississippi, Commonwealth Fund, Connecticut Health Foundation, Endowment for Health in New Hampshire, Fledgling Fund, National Institute for Health Care Management Foundation, Rita Allen Foundation, Robert Wood Johnson Foundation, and, in Texas, the Episcopal Health Foundation, Meadows Mental Health Policy Institute, Methodist Healthcare Ministries, and St. David’s Foundation.

The fellowship will run for nine days, beginning September 29, 2023. It is housed at Babson College’s Executive Conference Center in Wellesley, MA. Larry Tye, who covered health and environmental issues at the Boston Globe for 15 years, directs the program. A former Nieman Fellow and author of nine books, Tye has taught journalism at Boston University, Northeastern, Tufts, and Harvard.

Next fall’s fellowship will focus on a series of pressing issues – from preventing future pandemics to treating mental illness, rooting out racial and ethnic inequities, redressing homelessness, and rethinking later-life care. Attention also will be given to breakthroughs in medical treatments and curbing health-care costs.

The teaching will not end when fellows head back to their outlets. Tye, the program director, will be on call for the journalists for the full year following their nine days in Wellesley. He will help when they are stuck for ideas or whom to call on a story. He also will assist in thinking out projects and carving out clearer definitions of beats.

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.  More information is available at www.bluecrossmafoundation.org.

The Blue Cross Blue Shield of Massachusetts Foundation today announced it has awarded more than $850,000 in grants through a new program, Advancing Community-Driven Mental Health, to improve access to mental health services for adults experiencing mild to moderate distress and practical problems of daily living.

With its new, three-year grant program, the Foundation is taking an innovative approach to challenges in mental health care by leveraging an intervention developed by the World Health Organization.  The WHO model, called Problem Management Plus (PM+), helps adults learn how to manage adversity and mental health stressors in their day-to-day lives and provides community-based referrals to those at risk of developing severe mental health challenges.  The low-intensity psychological intervention also trains the non-clinical workforce to support people in mild to moderate mental health distress.

“Given the current state of the behavioral health crisis in Massachusetts, we believe it is critical to expand our knowledge of the role that non-clinical individuals can play in meeting the basic mental health needs of communities in a more socially and culturally relevant way,” said Audrey Shelto, President and CEO of the Blue Cross Blue Shield of Massachusetts Foundation.  “The WHO model is an evidence-based intervention with demonstrated success that we are eager to evaluate further through our new grant program and determine how it may be adopted more widely across the Commonwealth.”

The Advancing Community-Driven Mental Health grant program supports five nonprofit organizations that are focused on housing, senior services, support for people with disabilities, and other non-clinical initiatives that provide direct social or community services to individuals and families.  The following organizations have received $100,000 each through the first year of funding:

• Boston Senior Home Care, which will work to improve access to community-based mental health services through its supportive housing program in the Dorchester neighborhood of Boston, including training tenant service coordinators.
• Cambridge Economic Opportunity Committee, which will focus on underserved individuals including low-wage earners, those with limited English-language proficiency, people with disabilities, seniors and residents of subsidized housing.
• Quincy Asian Resources Inc., which will train its family and community services coordinators to support the mental health challenges of clients who have an immigrant background, typically speak Chinese or Vietnamese and have experienced acculturation stress.
• Stavros Center for Independent Living, which will implement the PM+ model to support people living with disabilities in western Massachusetts who have difficulty getting mental health services due to limited access to the internet and transportation.
• The Community Builders Inc., which will focus on individuals with low incomes and often in need of mental health care who live in family-designated affordable housing in Boston, Mashpee and Worcester.

In addition, the Foundation is providing a total of $355,779 in grant funding to its two technical assistance partners, The Family Van and Partners In Health, which are supporting the development and implementation of the grant program.  They are community-centered organizations with knowledge and experience with the PM+ model both locally and internationally.

“There is a need to increase the linguistic, racial and cultural diversity of the behavioral health workforce and to deliver mental health interventions in settings where people are already receiving services and support,” said Jacquie Anderson, the Foundation’s Senior Director of Grantmaking.  “With specialized training, non-clinical staff members at the community-based organizations supported by our grant program can play an important role in meeting the basic mental health needs of individuals.”

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 founded 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.

The Blue Cross Blue Shield of Massachusetts Foundation today announced $250,000 in grant funding to support nonprofit organizations that help connect new immigrants to resources and services for their health care needs in communities across the Commonwealth.

Each of the 10 organizations receiving funding from the Foundation’s Special Initiatives grant program has extensive experience assisting with the health care needs of immigrants, refugees, asylum seekers and migrants.  Their work has taken on a new level of urgency with the recent influx of individuals and families arriving in Massachusetts.

“Community-based organizations across Massachusetts have stepped up to meet the needs of families entering the United States with limited means, by connecting them with health care and other needed services,” said Audrey Shelto, President and CEO of the Blue Cross Blue Shield of Massachusetts Foundation.  “As we did when the COVID pandemic first hit, we are investing in the organizations on the front lines that are filling critical gaps and providing the life-sustaining services that these new members of our community urgently need.”

The Foundation regularly awards Special Initiatives grants, in addition to its major grantmaking programs, to support nonprofits that seek to positively impact health or health care access for Massachusetts residents who have been economically, socially, culturally or racially marginalized.

Each of the following organizations received $25,000 in one-year funding:

• African Community Economic Development of New England, of Roxbury, ensures that new immigrants and arriving refugee families have the support they need to successfully acclimate and thrive in their new home country.
• Agencia ALPHA, an immigrant-led grassroots organization in Boston, improves the quality of life of immigrants in Massachusetts by empowering community members to become leaders, overcome social challenges and fight xenophobia.  The nonprofit works in community organizing, legalization and citizenship services.
• Brazilian Women’s Group, located in Allston, promotes political and cultural awareness and contributes to the development of the Brazilian community.
• Centro Presente, a statewide Latin American immigrant organization based in East Boston, is dedicated to the self-determination and self-sufficiency of the Latino immigrant community of Massachusetts.
• Immigrant Family Services Institute, located in Mattapan, works to expedite the successful integration of recent immigrants into the social and economic fabric of the United States with justice and dignity.
• International Institute of New England, with offices in Boston and Lowell, creates opportunities for refugees and immigrants to succeed through resettlement, education, career advancement and pathways to citizenship.
• Rian Immigrant Center of Boston empowers immigrants, refugees and international exchange visitors to get on the path to opportunity, safety and a better future.
• Lawyers for Civil Rights, a Boston-based organization, works statewide with communities of color and immigrants to fight discrimination and foster equity through creative and courageous legal advocacy, education and economic empowerment.
• True Alliance Center Inc., a Mattapan organization, seeks to promote advocacy in the Haitian community related to education, housing, immigration, health and economic development.
• Volunteers in Medicine Berkshires, of Great Barrington, provides access to free, comprehensive health care for those in the Berkshires who are income-qualified and uninsured or underinsured.  It envisions a society in which everyone has an equal opportunity to achieve good health.

These grant recipients will meet with individuals and families to help determine their health needs and connect them with resources and services to meet those needs.  They will also coordinate as needed with other community-based organizations and local and state agencies to ensure that their services are additive, not duplicative.

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 founded 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.

The Blue Cross Blue Shield of Massachusetts Foundation released a research report today highlighting top health care priorities for the incoming governor and legislative leaders and action steps that can build on decades of progress and historic health care achievements.

The Foundation partnered on the research project with Manatt Health to solicit perspectives on health reform priorities from a broad and diverse group of health care stakeholders, including consumers, providers, health plans, business and labor.  The findings have been synthesized in the report titled, “A Focus on Health Care: Five Key Priorities for the Next Administration.”

Five priorities for immediate attention emerged from the interviews:

• Addressing systemic racism and inequities in health
• Ensuring consumer health care affordability
• Confronting the mental health crisis for children and youth
• Improving access to long-term services and supports, including long-term care
• Mitigating critical health care workforce shortages

“With the new administration taking shape on Beacon Hill, our goal is to encourage action on today’s most pressing health care challenges,” said Audrey Shelto, President and CEO of the Blue Cross Blue Shield of Massachusetts Foundation.  “Fortunately, state leaders do not need to start from scratch, as many of the action steps identified in our report build on existing or proposed initiatives. However, tackling these issues will require bold leadership, a collaborative approach, and long-term focus and investment.”

Each of the major health care system challenges identified in the report most acutely impacts people who have been economically, racially, culturally or socially marginalized.  This includes a workforce that on the one hand fails to reflect and respond to the diversity of the people it serves, while on the other disproportionately employs people of color in direct-care positions that offer low wages and modest benefits.

The report also points to persistent underinvestment in health care, public health and social systems in communities of color and rural communities in the state, as well as uncontained health care cost growth that is making coverage and care less affordable, especially for consumers of color.

“To meaningfully address the health care challenges and underlying inequities we elevate in our report, state leaders will need an approach to policy development that consistently and systematically engages a diversity of people with lived experiences,” said Shelto.  “We urge state leaders to partner with and empower the communities most impacted by these health care challenges in the design and implementation of lasting and effective solutions.”

The full report is available online at the following link: https://www.bluecrossmafoundation.org/publication/strengthening-health-care-commonwealth-priorities-next-administration

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 founded 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.

About Manatt Health

Manatt Health integrates legal and consulting services to better meet the complex needs of clients across the health care system. Combining legal excellence, firsthand experience in shaping public policy, sophisticated strategy insight and deep analytic capabilities, we provide uniquely valuable professional services to the full range of health industry players. Our diverse team of more than 180 attorneys and consultants from Manatt, Phelps & Phillips, LLP, and its consulting subsidiary, Manatt Health Strategies, LLC, is passionate about helping our clients advance their business interests, fulfill their missions and lead health care into the future.

Massachusetts’ historical achievements in bold and innovative health care policy have positioned the state as a national leader in transforming health care coverage, access, affordability, and quality. Yet despite decades of progress, the COVID-19 pandemic made it impossible to ignore that not all Massachusetts residents are able to access, afford, or experience health care equally.

In early 2022, anticipating the election of a new governor and slate of legislative leaders, the Blue Cross Blue Shield of Massachusetts Foundation in partnership with Manatt Health solicited perspectives on health reform priorities from a broad and diverse group of health care stakeholders, including consumer, provider, health plan, business, and labor representatives. This report synthesizes the findings from these stakeholder interviews, describing five health care priorities for the new governor and legislative leaders to immediately pursue: 1) addressing systemic racism and inequities in health; 2) ensuring consumer affordability of health care; 3) confronting the mental health crisis for children and youth; 4) improving the affordability of and access to long-term services and supports (LTSS); and 5) solving severe health care workforce shortages, particularly in the paraprofessional LTSS and behavioral health workforce.

The report explores each theme in detail and identifies specific action steps incoming state leaders can take to address these challenges. An accompanying executive summary and infographic provide a high-level overview that can be used by a wide audience. 

The Foundation’s Massachusetts Medicaid Policy Institute (MMPI) hosted a webinar with chart pack authors Carol Gyurina and Lissette Victoriano from the Commonwealth Medicine Division at the University of Massachusetts Chan Medical School. The goal of the webinar was to provide participants with basic background information about MassHealth, including what benefits MassHealth covers, who it serves, program spending, and a status update on the state’s delivery reform efforts.