This UPDATED (October 2022) edition of the MassHealth: The Basics chart pack provides new data on MassHealth enrollment and spending from the most recent state fiscal years available. The chart pack also features a high-level overview and status update on the state’s delivery system reform efforts, including a summary of the key elements of MassHealth’s latest 1115 demonstration waiver extension that was approved by the Centers for Medicare and Medicaid Services on September 28, 2022.

The chart pack provides comprehensive yet accessible data points and program updates to help policymakers, administrators, advocates, and academics better understand the complex MassHealth program. It is made available in PDF and PowerPoint formats to facilitate its use in presentations.

MMPI recently hosted a webinar to review facts and data about MassHealth eligibility, costs, and recent reforms from the latest edition of MassHealth: The Basics. Click here to access a recording of this webinar and a copy of the webinar slides.

The behavioral health workforce in Massachusetts is in crisis. The COVID-19 pandemic has increased the prevalence of behavioral health issues and demand for services, exposing and aggravating the vulnerabilities of Massachusetts’ behavioral health workforce and delivery system. Health care, including behavioral health care, has been among the industries hardest hit by the “Great Resignation,” exacerbating workforce shortages that predated the pandemic. These dynamics fuel an urgent call to action for Massachusetts to grow and support a workforce that can meet the pressing demand for behavioral health care in the Commonwealth. Informed by a literature review, the development of an inventory of promising models nationwide, and interviews with local and national stakeholders and experts, this report outlines seven concrete recommendations to expand Massachusetts’ behavioral health workforce, increase its diversity, maximize its potential to meet the needs of all people in the Commonwealth, and strengthen its resilience.

Massachusetts administers much of MassHealth through an 1115 Demonstration waiver, approved by the Centers for Medicare and Medicaid Services (CMS), which it has extended several times since it was originally approved in 1995. In December 2021, Massachusetts submitted a request to CMS to extend its Demonstration for another five years. While this request largely aims to continue and improve upon the programs and initiatives that are a part of the current Demonstration, an area of specific focus within the proposed extension centers around advancing health equity within the MassHealth program. As part of this request, MassHealth seeks to promote health equity by both building on current program elements and introducing new strategies such as investing in certain populations that experience persistent health inequities and creating incentives for ACOs and hospitals to measure and reduce health inequities.

This report describes the proposed MassHealth Demonstration extension, what it means for MassHealth coverage moving forward, and implications for members, providers, and other stakeholders.

Massachusetts, with support from the federal government, has implemented several policy and programmatic changes intended to promote continued access to health care services and health insurance coverage during the COVID-19 public health emergency. This table serves as a centralized resource that documents and describes the policy, regulatory, and administrative actions pertaining to MassHealth, Health Connector programs, and the Health Safety Net. This resource is intended to be used by advocates, enrollment assisters, and other stakeholders to assist consumers in identifying options to protect their access to coverage and health care services. Since policies and programs are changing frequently in the current environment, this resource will be regularly updated.

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The Foundation has committed to base its work in the structural racism and racial inequities in health focus area on issues raised by the communities and community members experiencing racism and health inequities. To that end, the Foundation partnered with established community-based organizations across the state to convene focus groups featuring the perspectives of community members on how racism impacts health and access to health care services. A total of seven focus groups, organized geographically, were held virtually. At each focus group, a total of eight to ten individuals participated, representing three to four organizations in each region. Focus group participants were selected based on the alignment of their organization’s work with the Foundation’s mission and focus areas.

The key themes that emerged related to two forms of racism: (1) racial bias in clinical care, which plays a key role in poor health outcomes for individuals and communities of color and (2) the policies and practices of health care systems and the legal and regulatory climate. The report summarizes those themes and presents recommendations, which include guidance for the types of programs and services that need support in communities, direction for the Foundation’s policy work, and considerations for grantmaking programs and processes.

The Blue Cross Blue Shield of Massachusetts Foundation released a report today outlining key strategies for maintaining Medicaid coverage when the federal government ends the COVID-19 public health emergency, a regulatory transition that will put many eligible individuals at risk of becoming uninsured.

States received enhanced Medicaid funding through the Families First Coronavirus Response Act, the first federal stimulus package passed by Congress in 2020 as the pandemic emerged.  As a condition of the increased funding, states agreed to maintain continuous coverage for Medicaid members – even if circumstances affected their eligibility – for the duration of the COVID-19 public health emergency.

With the pandemic now abating, the COVID-19 public health emergency is slated to end in July.  At that point, Massachusetts’s Medicaid program, MassHealth, will resume updating members’ eligibility through its usual redetermination process.  There are concerns that some members’ eligibility will not be verifiable while others may become newly eligible for Health Connector coverage but not successfully enroll.  The risk of coverage loss is especially acute for individuals who are homeless or have unstable housing, and others who have experienced changes in their employment, income and housing during the pandemic – social factors experienced disproportionately by people of color.

“We see potential for coverage loss that would only worsen the health inequities that became painfully apparent during the pandemic,” said Audrey Shelto, President and CEO of the Blue Cross Blue Shield of Massachusetts Foundation.  “Massachusetts has laid out a strong plan to minimize the risk of coverage loss during this transition; we encourage Massachusetts and other states to use every tool at their disposal to ensure that individuals who remain eligible for Medicaid stay covered and maintain access to needed health care.”

The Foundation’s report notes that redeterminations have always been a source of coverage loss for some Medicaid members nationally, including here in Massachusetts, in part because of administrative challenges in contacting individuals or ensuring they receive their paperwork.  Prior to the public health emergency, an estimated 1 in 10 Medicaid members nationally experienced coverage gaps – often called “churn” – that limited their access to preventive and primary care.

MassHealth has already taken steps to increase outreach to members and work with community-based organizations and Medicaid managed care plans to underscore the importance of updating eligibility information and expediting data requests related to redeterminations.

The report recommends additional steps that MassHealth should consider to help maintain coverage for eligible individuals, including:

• Processing pending redeterminations over a 12-month “unwinding” period permitted by the federal government, to spread out the workload and provide extra time to reach members.
• Proactively addressing returned mail by increasing efforts to get updated contact information, before coverage is terminated.
• Implementing a text messaging strategy to send reminders to members to respond to information requests.  Similar to many other states, MassHealth is working toward, but has not yet implemented, a text messaging strategy.
• Issuing clear guidance to Medicaid managed care plans and Accountable Care Organizations (ACOs) to set expectations for the renewal process, including outreach to individuals.
• Maintaining strong oversight and monitoring data, while providing regular updates on the redetermination process to community-based organizations, health plans and the public.
• Ensuring a smooth transition to the Health Connector, the state’s health insurance marketplace, for those no longer eligible for MassHealth coverage.

“The federal enhanced funding resulted in significant coverage gains and much-needed health care stability not only in Massachusetts but in Medicaid programs nationally during the pandemic,” Shelto said.  “It is critical to protect those coverage gains as we transition to a new phase after the public health emergency is technically over.”

The report, titled “The End of the Federal Continuous Coverage Requirement in MassHealth: Key Strategies for Reducing Covering Loss,” was commissioned by the Foundation’s Massachusetts Medicaid Policy Institute and produced by Manatt Health.  The report is available online at the following link: https://www.bluecrossmafoundation.org/publication/end-federal-continuous-coverage-requirement-masshealth-key-strategies-reducing-coverage

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.

An updated version of this issue brief is now available here.

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 is required to maintain continuous coverage in MassHealth during the federal COVID-19 public health emergency. When the continuous coverage requirement expires at the end of the month in which the public health emergency ends – which is currently slated for July 14, 2022 – MassHealth will resume its standard renewal, or “redetermination,” processes. As MassHealth begins to redetermine eligibility for a considerable volume of its members, there is a high risk that some individu­als who remain eligible will experience a loss in coverage. This brief includes a summary of MassHealth’s eligibility and enrollment approach for when it resumes normal eligibility and redetermination processes and describes additional strategies that MassHealth and other stakeholders can take to ensure that people who remain eligible stay covered.

This report provides an analysis of the impacts of the enhanced premium subsidies for purchasing health insurance through the Marketplace, or Health Connector in Massachusetts, that the American Rescue Plan Act (ARPA) temporarily authorized through 2022. While Massachusetts already provided additional state-based financial assistance to many marketplace enrollees prior to ARPA, ARPA enhanced subsidies for some individuals and introduced a new cap on the amount anyone purchasing through the Marketplace has to pay in premiums, effectively expanding eligibility for subsidies to purchase health insurance.

The Build Back Better Act that passed the House of Representatives and is currently stalled in the Senate would extend these subsidies through 2025. In this brief, we evaluate the coverage and cost effects of extending the enhanced subsidies in Massachusetts in 2023. The estimates suggest that, if extended, the enhanced subsidies would:

• reduce the number of people who are uninsured in Massachusetts by 8,000 people;
• reduce household spending on premiums for people who purchase subsidized coverage through the Health Connector; and
• save the state an estimated $133 million in spending on ConnectorCare subsidies in 2023.

The report provides a more detailed look at each of these effects and is intended to be a resource for health care advocates, policymakers, and other stakeholders to understand the impact of these subsidies expiring.

In December 2021, Governor Baker signed Chapter 102 of the Acts of 2021 into law. This legislation, often referred to as the “ARPA bill,” appropriates close to $4 billion, including $2.55 billion in funding directly from the federal American Rescue Plan Act (ARPA). ARPA was passed in March 2021 to provide money to states to start recovering from the effects of the COVID-19 pandemic. Chapter 102 invests money from ARPA in many areas, including housing, infrastructure, education, and economic development. Health services received $950 million in the law, with funding for physical health, behavioral health, long-term care services, and public health initiatives. This issue brief summarizes the key components of Chapter 102 that will affect health and health care in Massachusetts.

The Blue Cross Blue Shield of Massachusetts Foundation today is pleased to announce the appointment of two new members to its Board of Directors and also welcome a new senior staff member of the grantmaking team.

The new board members are Zamawa Arenas, founder and CEO of marketing consultancy Flowetik, and Dr. Kiame Mahaniah, CEO of Lynn Community Health Center.

Arenas is a skillful marketing strategist and entrepreneur who guides public health and health care organizations to engage with stakeholders and consumers for greater impact.  In leading Flowetik, she actively collaborates in the Greater Boston business and nonprofit communities, partnering with clients to advance equity and drive change in health care, education and economic development.

Across more than two decades, Arenas’ work has connected her with the Boston Public Health Commission, Hunger to Health Collaboratory, Massachusetts Coalition for Serious Illness Care, Massachusetts League of Community Health Centers and RIZE Massachusetts, among other organizations.

Arenas is a five-time Emmy award winner who has been inducted into the YWCA Academy of Women Achievers and recognized as a “Hispanic on the Move” by a leading business publication.  She is the recipient of the Greater Boston Chamber of Commerce’s Pinnacle Award honoring women for their outstanding contributions in the workplace and to enhancing the region’s quality of life.  She earned a master’s degree in in broadcast administration from Boston University.

“I am honored by the opportunity to join such a talented and diverse group of individuals who are dedicated to the Foundation’s important mission,” Arenas said.  “Even with all of the progress in broadening access to care as a direct result of the Foundation’s leadership, there is still more work to be done to improve health care access and coverage for all residents of the Commonwealth.”

Dr. Mahaniah is an experienced family physician and health care leader.  He has served as CEO of Lynn Community Health Center since 2017, rising from the role of chief medical officer focused on quality care and the patient experience in the community health setting.  He began his career as a staff physician at Greater Lawrence Family Health Center, before becoming the chief medical officer of North Shore Community Health.

Born in Philadelphia, Dr. Mahaniah draws inspiration from his childhood divided between the conflict-challenged African country of Congo and his education in Switzerland.  He is passionate about ending health disparities and his clinical interests include teaching and integrating opioid addiction treatment into primary care.

After graduating from Haverford College, he earned his Doctor of Medicine degree at Thomas Jefferson University in Philadelphia as a National Health Service Corps scholar, and graduated from the Family Medicine Residency program at the University of Pittsburgh Medical Center.  Among other honors, he was named the Massachusetts Academy of Family Medicine Physician of the Year in 2012-13.

“I am thrilled to join the Foundation’s board and bring my perspective as a physician and community health leader to its important work, particularly in the focus areas of addressing racial inequities in health and pursuing social in health care,” said Dr. Mahaniah.  “As leaders in our society, we have a responsibility to recognize and address any structural gaps that persist as disparities in access to quality, affordable health care.”

Reena Singh recently joined the Foundation as Senior Program Officer.  Singh oversees grant programs designed to expand access to health care for racially, ethnically, economically and socially marginalized communities Massachusetts.  In 2021, the Foundation’s grantmaking activity totaled nearly $4 million and included the launch of the Racial Justice in Health program to support grassroots nonprofit community organizations led by people of color.

Prior to joining the Foundation, Singh served as the director of campaign planning and communications at Voices for Healthy Kids, an initiative of the American Heart Association.  She previously provided coaching and technical assistance while working for Community Catalyst, a national nonprofit advocacy organization based in Boston.

Singh holds a master’s degree in public policy and administration from Columbia University, where she received the Harvey Picker Prize for Public Service.  She also participated in the Boston University Institute for Nonprofit Management and Leadership.

“Reena has tremendous experience advancing advocacy campaigns and collaborating with health justice organizations,” said Audrey Shelto, President and CEO of the Blue Cross Blue Shield of Massachusetts Foundation.  “Her focus on policy initiatives involving coverage, access and equity makes her an ideal addition to our team and will help propel the Foundation’s mission through her role supporting our major grantmaking programs.”

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.