Among state budget items, MassHealth is well known as one of the largest spending categories, while its role as a significant source of federal revenue is often overlooked. This brief takes a look beyond the budget totals to help stakeholders better understand the actual state cost of MassHealth when factoring in the state and federal partnership that finances this program. In fiscal year (FY) 2019, the state projects it will spend approximately $16.7 billion on MassHealth. This total (or “gross” amount) is approximately 36 percent of total estimated state spending for FY 2019. 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 $8.3 billion or 24 percent of total state spending in FY 2019. 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.

This collection of materials goes beyond the topline statistics often used to characterize those served by MassHealth in order to paint a richer, more meaningful picture of the more than one in four Massachusetts residents enrolled in the program. MassHealth serves our most vulnerable residents across their life spans from infants and children with special needs who gain access to comprehensive health care and support services required to reach their full potential, to the elderly and those living with disabilities who receive community based care that helps them remain in their homes. This detailed set of data and narrative profiles of MassHealth enrollees illustrate many of the life circumstances that create a need for MassHealth, and the various ways that MassHealth impacts individuals and their families. Fully understanding who MassHealth enrollees are and hearing from them about the role MassHealth plays in their lives is critical to informing policy and program development.

This project includes the following components:

1. A chart pack summarizing the demographic and socioeconomic characteristics of individuals enrolled in MassHealth as of June 2018.
2. Five journalistic profiles of a diverse set of real MassHealth members.
3. A databook that provides more detail on the quantitative findings presented in the chart pack.

This report and companion chart pack document and describe the current behavioral health (inclusive of mental health and substance use disorder) care system for children, adolescents, and adults in Massachusetts; outline a new whole-person-oriented vision for behavioral health care in the Commonwealth; and propose a strategic approach and series of recommendations through which the state can advance this vision to achieve reform. This new vision for behavioral health care in Massachusetts addresses some of the most pressing challenges impacting how behavioral health care is delivered today. Among others, these include: barriers to accessing and navigating the behavioral health care continuum, inadequate coverage of behavioral health care services across payers, workforce shortages and capacity issues, unnecessary regulatory burden and redundancy, fragmented administrative and payment functions, and lack of monitoring and accountability for behavioral health outcomes.

To develop this new vision, researchers interviewed and facilitated discussion groups with state and national behavioral health experts, stakeholders, and thought leaders, and conducted a comprehensive landscape scan of the current public and private behavioral health care system in Massachusetts. Researchers identified the system’s many strengths and persistent weaknesses and then constructed a “model” system to guide the new vision.

Findings from this report were featured at a Foundation event held earlier today. Click here to learn more about the event.

This collection of materials is the latest in a series by the Urban Institute summarizing the findings from the 2018 Massachusetts Health Reform Survey (MHRS). The Foundation began conducting the MHRS in fall 2006 to support the evaluation of Massachusetts’ 2006 health care reform bill. The survey has been fielded periodically since 2006 – most recently in spring 2018 – to monitor key measures pertaining to health insurance coverage and health care access and affordability among non-elderly adults (ages 19-64) in Massachusetts. For the first time in 2018, the MHRS included several questions pertaining to access to care for mental health (MH) and substance use disorder (SUD) services.

The 2018 MHRS highlights the state’s ongoing success at maintaining near-universal health insurance coverage since the passage of Massachusetts’ 2006 health care reform law. However, the survey’s core measures demonstrate that opportunities for improvements in access to and affordability of health care for the state’s residents remain and the new questions on MH/SUDs highlight the significant barriers to care and gaps in access to care faced by those seeking MH/SUD services. The survey findings are a reminder that the goals of health care reform are not fully achieved by simply reducing the number of people who are uninsured. New strategies are needed to improve access to care and reduce the burden of health care costs for Massachusetts adults and their families, particularly for the most vulnerable.

Findings from the 2018 MHRS were featured at a Foundation event held on December 11, 2018. Click here to learn more about the event.

This year’s results are presented in a variety of publications including:

This brief describes the potential impact in Massachusetts of a proposed rule, released by the Department of Homeland Security in October 2018, to change the process by which it determines whether an immigrant is inadmissible to the United States or unable to adjust status because the person is likely to become a “public charge.” The proposed Public Charge Rule would mark a significant shift from current policy by defining a “public charge” as a noncitizen who receives one or more public benefits. This brief also provides an estimate of the scope of immigrants in Massachusetts who may be impacted by the proposed rule and what effect that could subsequently have, both directly and as a result of the “chilling effect,” on enrollment in particular benefit programs, including MassHeath and the Children’s Health Insurance Program (CHIP).

In Massachusetts, MassHealth is implementing a number of reforms as part of its most recent Medicaid 1115 demonstration waiver extension to transform the delivery of care for most members and address the social determinants of health (SDOH). In light of the new interface between health care and social service delivery fostered by the MassHealth program redesign, it is important to understand how community-based organizations (CBOs) perceive the entry of health care organizations into their domains of social service delivery. While health care providers’ perspectives are frequently reported on, less is known about how CBOs view the opportunities and challenges associated with these new relationships.

This report aims to address this knowledge gap by summarizing the findings from a qualitative study that sought to better understand how CBOs are responding to the health care sector’s movement into SDOH programming in Massachusetts. Data was collected through 46 key informant interviews with CBO representatives from a range of social service sectors across the state. Informed by the study findings, this report outlines recommendations for health care leaders and policymakers to support the integration of health care and social service delivery.

This report seeks to inform the discussion of MassHealth sustainability through a novel analysis of MassHealth data that differentiates among the major drivers of MassHealth spending. The report examines whether spending is being driven by growth in enrollment or per-enrollee spending, and which populations or types of services are the biggest contributors to spending growth. The findings suggest that as enrollment growth tied to previous coverage expansions levels off, the state will increasingly need to focus on controlling per-enrollee spending, particularly in the areas of pharmacy and long-term services and supports (LTSS).

Following a review of the findings, this report proposes a series of tailored policy options informed by other states’ strategies to further understand and address spending growth in the areas of pharmacy and LTSS.

MassHealth introduced accountable care organizations (ACOs) for many of its members in March 2018. An ACO is a group of doctors, hospitals, and other health care providers that work together with the goals of delivering better care to members, improving the population’s health, and controlling costs. This brief serves as a resource for stakeholders (i.e., providers, health care administrators, policymakers) to help explain the key elements of MassHealth ACOs. A variety of topics are covered in this brief, including: member eligibility; ACO types; savings and losses; member enrollment and assignment; plan selection periods and fixed enrollment; primary care provider exclusivity; and ACO features, such as community partners.

This guidebook is designed to help health care administrators and providers better understand the types of social services available in Massachusetts, the organizations that provide such services, and their key sources of funding. This resource is intended to facilitate greater coordination between these organization types, and especially with MassHealth ACOs as they seek to integrate, better coordinate with social services, improve health outcomes, and reduce health care costs.

Based on valuable feedback from stakeholders, this guidebook has been revised. Among the updates made to the guidebook, this version includes a new section on facilitating agencies that directly provide or provide linkages to multiple types of social services.

This brief frames the key issues and potential impacts to Massachusetts consumers that may result from implementation of the federal proposed rule to expand the availability of Association Health Plans (AHPs). This brief:

• Describes the ways in which allowing AHPs to operate according to the proposed rule could impact the scope of benefits, provider networks, and consumer protections available to consumers in plans covered through this arrangement;
• Explains technical topics such as risk segmentation and rating rules and why they are important in considering the impacts of the proposed AHP rule on consumer access to health coverage; and
• Provides policymakers with options the Commonwealth could consider to protect consumers in response to the federal AHP proposal.

This brief provides an overview of the steps that Massachusetts has taken to establish a functioning insurance market that provides consumers with meaningful access to health coverage. It includes a review of statutory and regulatory provisions in place today, and provides context for key health reform initiatives that have occurred over the past 30+ years. This brief is structured around four key components of a functioning market for health coverage:

1. Encouraging or requiring coverage of a comprehensive set of benefits and services;
2. Ensuring fair competition among insurance carriers;
3. Providing access to coverage, particularly for low- and middle-income residents; and
4. Instituting mechanisms to protect consumers.

The policies and provisions described in this brief have played an important role in the evolution of the Massachusetts market, helping the state achieve near-universal coverage, enabling most Massachusetts employers to offer comprehensive coverage to their employees, establishing a competitive market for health coverage, and protecting consumers.

Given the impact that social factors have on health status and expenditures, and the shift toward value-based payment models that reward providers based on outcomes, health care organizations (HCO) and community-based organizations (CBO) across the country are increasingly working together to address patients’ social needs. In Massachusetts, MassHealth is investing in accountable care organizations and community partners to integrate physical health, behavioral health, and long-term services and supports and also funding certain approved “flexible services” that address health-related social needs that are not otherwise covered as MassHealth benefits.

Based on a review of promising HCO-CBO partnership models, this brief outlines characteristics of effective HCO-CBO partnerships and provides recommendations to guide the development of successful collaborations between health care and social service organizations. 

This brief prioritizes issues for consideration as accountable care organizations (ACOs) and managed care organizations (MCOs) prepare to integrate and fully manage comprehensive long-term services and supports (LTSS) over the course of Massachusetts’ five year 1115 waiver extension. The identified priority areas were informed by lessons learned from managed LTSS programs in other states and interviews with key stakeholders in Massachusetts. This brief concludes with a series of detailed descriptions of the institutional and community LTSS covered under the Medicaid state plan that will eventually be integrated into ACOs and MCOs.

Based on valuable feedback from stakeholders this brief has been revised to better distinguish between certain services, in particular, adult foster care and group adult foster care.

The fourth edition of the tracking tool provides a detailed description of key components of Chapter 224, highlighting the progress the state has made in its implementation of the law as of November 2017. This tool is designed for policymakers, advocates, and other stakeholders who wish to track when and how state leaders have addressed policy issues pertaining to Chapter 224.

This year’s release includes two distinct versions of the tracking tool: 1) An abbreviated version that focuses on progress the state has made since September 2016; and 2) A more comprehensive version which documents progress the state has made in implementing the law since its passage in 2012.

If you have any suggested additions or corrections, please email [email protected].

This series of reports describes the results of a comprehensive mixed-methods study, Access to Outpatient Mental Health Services in Massachusetts. The study sought to quantify the wait times for outpatient mental health office visits in Massachusetts, better understand the experiences of clients seeking an appointment, and identify facilitators and barriers to accessing mental health services. Study findings are based on primary data from multiple sources, including qualitative data from stakeholder interviews and client focus groups and quantitative data from surveys of clinicians and administrators at organizations providing outpatient mental health services.

Findings from this study were featured at a Foundation event held on October 31, 2017. Click here to learn more about the event.