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. 

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.

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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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.

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) 2022, the state projects it will spend approximately $19.2 billion on MassHealth. This total (or “gross” amount) is approximately 36 percent of total estimated state spending for SFY 2022. 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 $8.5 billion or 22 percent of the total state spending in SFY 2022. 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.

Health care payers, providers, and policymakers are increasingly pursuing value-based payment (VBP) to improve the quality of care and population health while controlling rising health care costs. When implemented in Medicaid, VBP programs often include children and adults in the same model, though these models may not fully account for children’s distinct health needs.

This report seeks to inform the work of Massachusetts policymakers and stakeholders to better incorporate children’s health needs and experiences within the payment models in the MassHealth Accountable Care Organization (ACO) Program by examining lessons from states and providers throughout the country.  Based on the results of an environmental scan, including a review of peer-reviewed and gray literature and interviews with 18 subject matter experts, this report identifies and describes four main VBP approaches for delivering care to pediatric populations. The authors then synthesize key themes and lessons learned for successfully implementing VBP models for children. These findings suggest there is great opportunity for Massachusetts to serve as a leader in this field, and the report lays out a set of policy and program considerations to help Massachusetts design an approach to better serving children within and alongside the framework of the existing ACO Program. Ultimately, adapting VBP for pediatric populations requires recognition that pediatric VBP models should not be focused on short-term savings but rather on improving quality of care to support child health and long-term population health outcomes.

This budget brief highlights the state fiscal year (SFY) 2021 budget – which ran from July 1, 2020 through June 30, 2021 – for MassHealth and other health reform programs. The SFY21 budget was delayed by six months due to the COVID-19 pandemic and the resulting economic challenges and fiscal uncertainty. Included within the budget was $18.9 billion designated for health care coverage programs and related operational expenses. This brief provides an analysis of spending in the SFY2021 budget associated with MassHealth and other health care coverage and health reform activities, as well as a summary of new initiatives included in the SFY2021 budget that are expected to impact MassHealth program spending.

This five-part series of issue briefs describes MassHealth’s impact on the health and finances of its members, families, and communities, as well as on the wide variety of stakeholders and sectors outside of the traditional health care realm that benefit from the program, including:

• the Commonwealth’s schools and school‐aged children, teens, and young adults;
• the state’s economy and businesses, including how MassHealth supports working families, reduces uncompensated care costs, and draws federal funds into the state;
• the behavioral health care system, addressing how MassHealth provides coverage, access, and delivery of services across the full behavioral health care continuum; and
• justice-involved persons, describing how MassHealth supports re-entry into the community.

Key findings from this series were featured at a Foundation virtual event on Wednesday, June 30^th from 2:00-4:00 pm. Click here to view event materials.

This report describes the results of a qualitative analysis of the MassHealth Accountable Care Organization (ACO) program over its first two years of operation. The Foundation commissioned this report to provide timely insight into what is working well, challenges stakeholders are facing, and opportunities to strengthen the program. The findings from this analysis are intended to fill a current gap in publicly available data evaluating the ACO program; they elevate the perspective of organizations operating within this new program, and can be used to help inform policymakers and administrators as they continue to build on and refine the ACO program.

This analysis was informed by a series of interviews with 34 individuals representing 21 organizations, including ACOs, managed care organizations, Long-Term Services and Supports and Behavioral Health Community Partners (CPs), Social Services Organizations (SSOs), and other stakeholders involved in the program. The following five key themes emerged from this research:

1. Interviewees overwhelmingly support the Accountable Care Organization program and praise MassHealth’s stakeholder engagement efforts to improve the program.
2. Interviewees report progress toward improving care delivery but acknowledge that making a measurable impact on health outcomes takes time.
3. The Accountable Care Organization program sparked the formation of beneficial partnerships among Accountable Care Organizations, Community Partners, and Social Service Organizations.
4. The Community Partner Program’s complexity created a burden for Accountable Care Organizations and Community Partners.
5. The Flexible Services Program is promising, but relationships between Accountable Care Organizations and Social Service Organizations could benefit from more structure.

To ensure future success of the ACO program, the report also makes specific programmatic recommendations for strengthening the program moving forward. These recommendations focus on: (1) supporting improved communication and data sharing among ACOs, CPs, and SSOs; and (2) addressing structural elements of the program that hinder partnerships in the CP and Flexible Services Programs.

Of the more than 1.8 million people enrolled in MassHealth, Massachusetts’ Medicaid program, one in five are dually eligible and receive health care coverage through two distinct payers – Medicare and MassHealth. This educational primer was developed to build a deeper understanding of the dual eligible population in Massachusetts. It illustrates the diversity of dual eligible individuals’ clinical and functional needs, service utilization, and spending patterns. The primer also describes the program options that are available to meet their needs, with a particular focus on MassHealth’s integrated care programs – One Care, the Program of All-Inclusive Care for the Elderly (PACE), and Senior Care Options (SCO). Also included in the primer is a description of the state’s proposed reforms, known as the Duals Demonstration 2.0, to increase enrollment in One Care and SCO and improve care integration and quality for dual eligible members.

The primer consists of four components:

• An issue brief, which provides an overview of the characteristics of dual eligible members in Massachusetts and the costs associated with their care, as well as of the coverage landscape for the state’s dual eligible individuals and key objectives of the Duals Demo 2.0;
   
• An in-depth comparative assessment of the integrated care programs available to dual eligible members in Massachusetts;
   
• A data chart pack, which offers a detailed analysis of enrollment, demographics, and spending trends among dual eligible individuals in Massachusetts; and
   
• A set of five profiles of dual eligible members enrolled in integrated care and fee-for-service delivery systems in Massachusetts.

This resource highlights the most recent monthly enrollment data available for MassHealth and ConnectorCare — the two most prominent sources of publicly financed health insurance in Massachusetts. The compiled data and highlighted trends described in this resource are intended to help policymakers, health care stakeholders, and others track how enrollment in these programs has changed since the COVID-19 pandemic began affecting public health and the economy of the Commonwealth. This resource will be updated regularly with the latest enrollment data as it becomes available.

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This educational brief describes the key elements of the Affordable Care Act (ACA) and provides an overview of California v. Texas, a case currently before the U.S. Supreme Court that seeks to overturn the ACA. Also included in this brief is a discussion of recent relevant case history and how the arguments in California v. Texas build upon prior legal challenges to the ACA.