This report, prepared by Sharon Long and Thomas Dimmock of the Urban Institute, further analyzes the 2013 Massachusetts Health Reform Survey (MHRS) by comparing the experience of adults with public coverage to adults with employer-sponsored insurance (ESI) coverage across a number of access and affordability measures. Findings from the analysis show problems with access to care were more prevalent for adults with public coverage than for those with ESI. These disparities persist even after controlling for variations in health care needs and socioeconomic status between the two groups. The persistence of gaps in access to care for adults with public coverage raises concerns about systemic barriers to care within the Massachusetts health care system.

In conjunction with the full report, the authors developed a one-page summary highlighting key findings from the analysis.

This report, prepared by Margaret Houy and Michael Bailit of Bailit Health Purchasing, LLC, provides a comprehensive review of the policy and regulatory barriers that impede behavioral health integration in Massachusetts and identifies potential options for addressing these barriers. This report is divided into three sections – licensing, privacy, and, reimbursement barriers – and was developed through a review of reports and other secondary sources, agency regulations and checklists, and interviews and a focus group with key stakeholders. Incorporating the input from the focus group, it concludes with a discussion of the top three priorities that, if addressed, would have the most significant impact on removing barriers to integration. This report is intended to serve as a resource summarizing key issues and potential opportunities for policymakers to improve the integration of physical and behavioral health care services.

This brief describes the Massachusetts Senate fiscal year (FY) 2016 budget proposal for MassHealth (Medicaid) and other subsidized health coverage programs and compares it to the proposal put forth by the House. It is the third in a series of FY2016 budget briefs produced by the Massachusetts Medicaid Policy Institute (MMPI) in partnership with Rob Buchanan and Tom Dehner of Health Management Associates. MMPI will be publishing budget briefs at several stages in the FY2016 budget process as proposals move through the state legislature.

In this issue brief, Patricia Boozang, Deborah Bachrach and Hailey Davis of Manatt Health Solutions, review the coverage and delivery system challenges that Massachusetts could address through sections 1331 (the Basic Health Program) and 1332 (Waivers for State Innovation) of the Affordable Care Act (ACA). This brief describes the federal requirements related to these sections of the law and identifies the options the Commonwealth could pursue to advance its coverage, fiscal, and policy priorities, including: improving affordability and ease of access to coverage for low-income residents, continuing the expansion of insurance coverage to hard-to-reach populations, and evaluating and revisiting policy decisions like the individual mandate to determine the best fit for Massachusetts.

In this issue brief, Patricia Boozang, Deborah Bachrach and Hailey Davis of Manatt Health Solutions, review the coverage and delivery system challenges that Massachusetts could address through sections 1331 (the Basic Health Program) and 1332 (Waivers for State Innovation) of the Affordable Care Act (ACA). This brief describes the federal requirements related to these sections of the law and identifies the options the Commonwealth could pursue to advance its coverage, fiscal, and policy priorities, including: improving affordability and ease of access to coverage for low-income residents, continuing the expansion of insurance coverage to hard-to-reach populations, and evaluating and revisiting policy decisions like the individual mandate to determine the best fit for Massachusetts.

In 2014, the Foundation partnered with the city of Boston to conduct a thorough analysis of the scope of Boston's substance use addiction problem and selected DMA Health Strategies to conduct the research. With the Mayor’s Office, the Foundation also assembled an Addiction Recovery Advisory Group comprised of addiction experts and community stakeholders to work closely with the researchers. This report, which focuses on how to better align the city of Boston’s addiction and recovery services with demonstrated best practices, will serve as a roadmap for the Mayor’s Office of Recovery Services.

Peter Hussey, Courtney Armstrong, and Eric Schneider of the RAND Corporation conducted interviews with seven health plans and five Accountable Care Organizations (ACOs) to determine their support for innovative delivery system models including payment arrangements, program development strategies, and the criteria decide whether or not to support these programs. All interviewees are currently engaged in innovative care delivery efforts aimed at improving quality and reducing the cost of healthcare and believe that the current payment system has not moved far enough away from fee-for-service to support meaningful delivery system changes. The report suggests that a shift towards alternative payment methodologies, an alignment of incentives across payers, and a better understanding of the impact of care delivery transformation are all necessary to achieve sustainability. The authors find that the main challenge in innovation will building capacity and managing financial risk, particularly for smaller and less-experienced provider organizations.

Click here to read the report.

This brief describes the Massachusetts House of Representatives fiscal year (FY) 2016 budget proposal for MassHealth (Medicaid) and other subsidized health coverage programs. It is the second in a series of FY2016 budget briefs produced by the Massachusetts Medicaid Policy Institute (MMPI) in partnership with Rob Buchanan and Tom Dehner of Health Management Associates. MMPI will be publishing budget briefs at several stages in the FY2016 budget process as proposals move through the state legislature.

In this report, Carol Gyurina, Jennifer Rosinkski and Robert Seifert of the University of Massachusetts Medical School, analyze several factors that help explain why health care affordability continues to be a challenge in Massachusetts, even after achieving near universal health insurance coverage. Beginning with an analysis of data largely collected through the Massachusetts Health Reform Survey (MHRS), the report provides an overview of the factors influencing health care affordability and summarizes the financial and access to care consequences for consumers struggling with health care costs. The remainder of the report is devoted to sharing the personal stories of four individuals in Massachusetts who have experienced first-hand the challenges and consequences of unmanageable health care costs.

This brief describes the governor's fiscal year (FY) 2016 budget proposal for MassHealth (Medicaid) and other subsidized health coverage programs. It is the first in a series of FY 2016 budget briefs produced by the Massachusetts Medicaid Policy Institute (MMPI) in partnership with Rob Buchanan and Tom Dehner of Health Management Associates. MMPI will be publishing budget briefs at several stages in the FY2016 budget process as proposals move through the state legislature.

Unless Congress acts, federal funding for the Children’s Health Insurance Program (CHIP) will run out soon after September 2015. On March 26, the U.S. House of Representatives passed legislation that would fund CHIP for two more years. The Senate is expected to take up the bill in mid-April. This report, written by Robert Seifert of the Center for Health Law and Economics at the University of Massachusetts Medical School, examines the serious implications for Massachusetts if federal funding for CHIP is not extended.

This brief and set of detailed tables, prepared by Sharon Long and Thomas Dimmock from the Urban Institute, provide estimates of the number and rate of uninsurance in Massachusetts by various geographic units ranging from congressional districts to counties to neighborhoods. The resource is based on the 2009 to 2013 five-year file of the American Community Survey (ACS), which included a sample of 140,001 people in Massachusetts.

The brief summarizes high level findings from the data and definitions for the geographic units of analysis. The appendices provide data on the estimates of the number and rate of uninsurance by the following categories: all persons, males, females, children (ages 0-17), non-elderly adults (ages 18-64), and elderly (ages 65+). Each appendix provides these results for 10 different geographic units ranging from congressional district to county to census tract.

Megan Burns and Michael Bailit of Bailit Health Purchasing, LLC, provide a comprehensive review of payment reform in Massachusetts and, in particular, how the changing landscape is affecting safety-net providers. For this report, safety-net providers—those providers characterized by serving a high percentage of Medicaid beneficiaries and uninsured individuals—includes both community health centers and hospitals. Building off state-collected data that details the adoption of alternative payment models (APMs) by payers over the course of 2012 and 2013, the report adds qualitative findings gathered from a sample of payers and providers in mid-2014. The qualitative findings focus on the variation in characteristics of Massachusetts global payment arrangements and the impact the contracts are having on safety-net providers. The report concludes with several recommendations that payers, the state, or foundations could provide to aid safety-net providers in their preparation for payment reform.

This report, written by Robert Seifert, Michael Grenier, and Jean Sullivan of the Center for Health Law and Economics at the University of Massachusetts Medical School, summarizes the history of the MassHealth 1115 waiver and examines the key components of the new waiver extension, organized around five themes: coverage, services, delivery redesign, support for the safety net, and looking to the future. This most recent waiver extension, which the Centers for Medicare and Medicaid Services (CMS) granted in October 2014, is for five years (until June 30, 2019). However, a major component—the Safety Net Care Pool—was extended for only three years (until June 30, 2017), with the terms for the remaining two years subject to further negotiation.

In conjunction with the full report, the authors developed an abbreviated summary of the MassHealth 1115 waiver, which provides an overview of the new provisions approved under the waiver renewal.

Responsible for the health care coverage of nearly two million residents and $13.7 billion in related expenditures, the future of MassHealth matters to all of us. This report, by Manatt Health Solutions, includes a series of recommendations that emerged through interviews with consumer advocates, providers, insurers, business leaders, public officials, and policy experts as priorities for the next governor.

Findings from this report were featured at a Foundation event held on December 9, 2014, MassHealth Matters: Priorities for the New Administration. Click here to learn more about the event and to see a copy of the slide presentation of the report by Patricia Boozang, Managing Director of Manatt Health Solutions.

Click here to watch the MassHealth Matters video.