This UPDATED (October 2024) 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 features a high-level overview of the delivery systems that serve MassHealth members. It also highlights MassHealth’s latest reform efforts, which include initiatives to advance health equity, to expand services and coverage to certain groups, and to improve timely access to behavioral health care.

The chart pack provides comprehensive yet accessible data and explanations of 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.

On November 20, 2024, MMPI hosted a webinar to review facts and data about MassHealth eligibility, benefits and delivery systems, 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.

NOTE: This report is also available in English. Click here to view the report in English.

A la luz de los crecientes esfuerzos de MassHealth y otras agencias de Medicaid para colaborar con las personas que han vivido la experiencia de Medicaid y con el fin de mejorar los resultados de salud y avanzar en la equidad, la Fundación encargó dos reportes informativos. El primer reporte, Estrategias para Involucrar Significativamente a los Miembros de MassHealth para Informar las Decisiones de Programas y Políticas, se publicó en junio de 2024 e hizo una serie de recomendaciones para reforzar la estrategia general de participación de los afiliados de MassHealth.

Este segundo informe examina en profundidad una herramienta específica de participación de los afiliados: Los Consejo de Asesores Comunitarios (CABs). Los CABs son grupos de personas, incluidos miembros actuales y antiguos de Medicaid, que participan en un diálogo estructurado, coherente y a largo plazo para informar sobre el diseño de políticas y programas de Medicaid. MassHealth, las organizaciones de atención administrada y las organizaciones de atención responsable ya emplean CABs para informar programas específicos de MassHealth, y MassHealth ha anunciado su intención de crear CABs para todo el programa.

Este informe busca identificar prácticas prometedoras para el diseño y la implementación de CABs en el contexto de MassHealth. Basándose en un análisis de entorno, entrevistas con partes interesadas y conversaciones con los propios miembros de MassHealth, este informe delinea principios rectores o “north stars” [estrellas del norte] para establecer CABs. También detalla recomendaciones prácticas para diseñar y operar CABs eficaces.

NOTA: Este informe también está disponible en inglés. Consulte nuestra página de inicio en español para este informe aquí. 

In light of increased efforts by MassHealth and other Medicaid agencies to engage with individuals who have lived experience with Medicaid and in order to improve health outcomes and advance equity, the Foundation commissioned two informative reports. The first report, Strategies for Meaningfully Engaging MassHealth Members to Inform Program and Policy Decisions, was released in June 2024 and made a series of recommendations to strengthen MassHealth’s overall member engagement strategy. 

This second report takes a deeper look at one specific member engagement tool: Community Advisory Boards (CABs.) CABs are groups of people including current and former Medicaid members that engage in structured, consistent, and long-term dialogue to inform Medicaid program and policy design. MassHealth, managed care organizations, and Accountable Care Organizations already employ CABs to inform specific MassHealth programs, and MassHealth has announced its intention to create a program-wide CAB.

This report aims to identify promising practices for design and implementation of CABs in the context of MassHealth. Based on an environmental scan, stakeholder interviews, and conversations with MassHealth members themselves, this report outlines guiding principles or “north stars” for establishing a CAB. It also details practical recommendations for designing and operating effective CABs. 

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. 

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.

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.

Long term services and supports (LTSS) are the critical services and supports that people with disabilities and chronic conditions of all ages use to meet their daily living needs, remain independent, and participate in their communities. This primer provides a thorough landscape assessment of LTSS in Massachusetts and serves as a follow-up to the Foundation’s December 2022 report, A Focus on Health Care: Five Key Priorities for the Next Administration, which identified improving access to LTSS as one of five key areas requiring immediate and focused action in Massachusetts.  

This primer is intended to help stakeholders better understand LTSS in Massachusetts: what these services are, who uses them, and how they are delivered and paid for. In summarizing the available data on LTSS payers and programs, utilization and spending, workforce capacity, and quality, the primer highlights the strengths and the challenges in LTSS delivery and access in Massachusetts today.  It also identifies opportunities and considerations for improving access to and quality of LTSS in Massachusetts.

Federal law requires states to recoup costs from certain Medicaid members’ estates – the money and possessions left after someone dies – if they received long-term services and supports (LTSS), such as care in a nursing facility or at home. But some states, including Massachusetts, exceed the federal minimum and recover the cost of all Medicaid-covered services that are provided to members over age 55. This means far more members are affected because it is not just limited to those who use LTSS. By limiting the passing down of assets – including homes – the practice of estate recovery may perpetuate wealth disparities and intergenerational poverty. While MassHealth has made reforms in recent years to reduce the burden of estate recovery on impacted members and families, more can be done.

These materials are intended to educate stakeholders, policymakers, and others about MassHealth’s estate recovery program. They include:

• An issue brief that describes Massachusetts’ estate recovery policy and practices and what is known about its impact on members and their families. The brief also identifies policy and programmatic options that the state could pursue to reduce the burden of estate recovery.
• A series of qualitative profiles that tell the stories of how estate recovery has impacted four individuals in Massachusetts after the loss of a loved one.

MassHealth provides health care services to over 2 million Massachusetts residents. This updated 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.

Peer supports are an important component of the health care system in Massachusetts. Peers provide a vital bridge to services by offering empathy, information, encouragement, and navigational assistance to people who face linguistic and cultural access barriers, stigma, absence of a support network, and other challenges. Peers are part of the communities they serve and often share lived experiences with the individuals they work with, making them uniquely qualified to foster trust in the health care system where it might be lacking. The nature of peers’ work is often well known in their own professional and programmatic circles, but understanding of their role is less clear across the broader health care system. This brief provides an overview of the primary professions that comprise the peer workforce in Massachusetts, where they work, and the various approaches to training, certification, and payment of these providers.

MassHealth introduced Accountable Care Organizations (ACOs) in 2018 as an option for most of its members under age 65. As of June 2023, over 1.3 million members – more than half of MassHealth’s total membership – are enrolled in one of 17 MassHealth ACOs.

This report was developed as a resource for stakeholders to help explain the key elements of MassHealth ACOs, including the two types, who they serve, and the services they provide. It includes information on the following:

• The history, structure, key features, and payment model of the ACO program.
• Information on who is eligible for MassHealth ACOs, the enrollment process, and ACO enrollment as of June 2023.
• Details on enhanced services that are provided to certain ACO members.
• A review of what is known about how ACOs have performed to date.

This UPDATED (October 2023) 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 features a high-level overview of the delivery systems that serve MassHealth members. It also highlights MassHealth’s latest reform efforts, which include initiatives to advance health equity and to improve timely access to behavioral health care.

The chart pack provides comprehensive yet accessible data and explanations of 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.

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. On September 28, 2022, CMS approved Massachusetts’ request for a five-year extension of its Demonstration, which is in effect from October 1, 2022 through December 31, 2027. While the latest approved Demonstration largely aims to continue and improve upon the programs and initiatives that were part of the previous Demonstration, an area of specific focus within this extension is advancing health equity within the MassHealth program. As part of this, 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 disparities and creating incentives for ACOs and hospitals to measure and reduce health disparities.

This report and accompanying infographic describe the approved MassHealth Demonstration extension, what it means for MassHealth coverage moving forward, and implications for members, providers, and Massachusetts.

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.