The MassHealth Proposed Demonstration Extension 2022–2027: Building on Success, Focusing on Equity

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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.

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UPDATED! Promoting Access to Care and Coverage During a Public Health Crisis: COVID-19–Related Changes Affecting MassHealth, Health Connector, and Health Safety Net

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.

Stay up to date on changes to this resource by signing up for our email list.

The End of the Federal Continuous Coverage Requirement in MassHealth: Key Strategies for Reducing Coverage Loss

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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.

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Health Care in the ARPA Bill: Selected Highlights from Chapter 102 of the Acts of 2021

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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.

Opening the Door to Behavioral Health Open Access in Massachusetts

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Addressing timely access to behavioral health care through the adoption of open access methods supports the well-being of people with behavioral health conditions, improves staff productivity, and increases financial stability for provider organizations. However, no study has previously documented the experience of provider organizations using this model in Massachusetts.

The report identifies organizations that operate open access today and highlights the approaches that have been most successful. The report also pinpoints keys to success for organizations to consider in adopting an open access model and offers policy recommendations to promote the broader adoption of open access in the Massachusetts behavioral health care system.  The case studies provide detailed descriptions of each model, describe the successes and challenges of implementation, and indicate how COVID-19 has impacted operations.

MassHealth Impact Series

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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 30th from 2:00-4:00 pm. Click here to view event materials.

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The MassHealth Accountable Care Organization Program: Uncovering Opportunities to Drive Future Success

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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.

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A Primer on the Dual Eligible Population in Massachusetts

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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.
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The Preventive Effect of Housing First on Health Care Utilization and Costs Among Chronically Homeless Individuals

Housing First programs offer chronically homeless individuals immediate housing as a foundation for the delivery of a range of other supportive services, such as mental health and/or substance use disorder services and social service supports. This report summarizes a study examining the effect of the Housing First model on health care utilization and costs among chronically homeless individuals enrolled in MassHealth. The findings from this study demonstrate the effectiveness of a permanent housing and supportive services program in reducing total health care utilization and costs among chronically homeless individuals.

Behavioral Health Urgent Care: A Vision for Massachusetts and Opportunities to Improve Access

Behavioral health urgent care services are a critical component of the broader behavioral health care delivery system. Developing and sustaining a robust set of behavioral health urgent care services across community-based settings will provide adults with more options for timely access to care and offer alternatives to emergency departments for treatment. This brief proposes a vision and framework for behavioral health urgent care and outlines a series of policy and programmatic recommendations to address workforce, clinical, payment, and administrative barriers to implementing behavioral health urgent care.  Addressing these barriers will advance access to and availability of behavioral health urgent care services for adults in Massachusetts.

This brief complements the Foundation’s Behavioral Health Urgent Care grant program, through which the Foundation is supporting Emergency Services Programs (ESPs) to bolster their capacity to deliver behavioral health urgent care services in Massachusetts. The work of the ESP grant partners and insights from other key stakeholders informed the proposed vision and key elements of the behavioral health urgent care framework as well as the recommendations outlined in this brief.

MassHealth: The Basics – Facts and Trends (October 2020)

This UPDATED (October 2020) edition of the MassHealth: The Basics chart pack provides new data on MassHealth enrollment and spending from the most recent state fiscal years available, as well as a high-level overview and status update on the state’s delivery system reform efforts. The 2020 chart pack features a summary of the many temporary policy and programmatic changes that MassHealth quickly implemented in response to the COVID-19 pandemic.

The chart pack provides comprehensive yet accessible data points and updates on the complex MassHealth program that will be useful to policymakers and administrators, as well as advocates and academics. It is made available in PDF and PowerPoint formats to facilitate its use in presentations.

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The Final Public Charge Admissibility Rule: Implications for Massachusetts

The revised federal public charge rule – which was finalized in August 2019 and took effect in Massachusetts in February 2020 – makes it harder for certain low- and moderate-income immigrants to obtain green cards or visas if they have applied for or enrolled in public benefits such as MassHealth or the Supplemental Nutritional Assistance Program (SNAP). This report describes the expected effects of the revised federal public charge rule on MassHealth and SNAP enrollment, and its downstream effects on the health of Massachusetts residents, health care providers, and the state’s economy.

This report updates and builds upon a November 2018 publication, The Proposed Public Charge Rule: An Overview and Implications in Massachusetts, which featured a similar analysis based on the proposed public charge rule. This current report analyzes the impact of the final rule, uses more recent data as the basis for its estimates, and updates the methodology based on new information. The estimates in this report do not account for strategies that are taking place within Massachusetts to try to mitigate the impact of public charge on enrollment in MassHealth - including intensive outreach and education in immigrant communities.

Expanding Access to Behavioral Health Care in Massachusetts through Telehealth: Sustaining Progress Post-Pandemic

At the onset of the COVID-19 public health emergency, Massachusetts led the nation in rapidly deploying progressive policies to temporarily expand access to telehealth. These changes have enabled significant increases in adoption of telehealth, including telebehavioral health, for providers and consumers in a short period of time. Prior to COVID-19, utilization of telebehavioral health had not gained widespread spread traction in Massachusetts despite its potential as a means to dramatically improve access to behavioral health care services, particularly for vulnerable populations.

This report provides policymakers and other behavioral health stakeholders with an overview of the state’s current telebehavioral health landscape; a description of the attributes of an optimal telebehavioral health care delivery model; and a summary of the common barriers to provider and consumer adoption of telebehavioral health services in Massachusetts. It also outlines a series of policy and programmatic recommendations – including maintaining many of the temporary policy advances made during the COVID-19 pandemic – that will better enable the delivery of telebehavioral health care and support increased consumer engagement with and use of telebehavioral health services.

What to Know About ACOs: The Latest on MassHealth Accountable Care Organizations

This brief builds upon a July 2018 publication, What to Know About ACOs: An Introduction to Accountable Care Organizations, which was developed as a resource for stakeholders (i.e., providers, health care administrators, and policymakers) to help explain the key elements of MassHealth ACOs, including the three types of ACOs, who they serve, and the services they provide. With Year 2 of the MassHealth ACO program now well underway, this updated edition provides information on new developments in the structure and features of the ACO program, including:

  • Expanded information about the Community Partners Program;
  • A new section explaining the Flexible Services Program;
  • A list of the finalized measures by which ACO quality will be assessed; and
  • Updated enrollment data, timelines, and resources for additional information.

MassHealth: The Basics – Facts and Trends (July 2019)

This UPDATED (July 2019) edition of the MassHealth: The Basics chart pack provides new data on MassHealth enrollment and spending from the most recent state fiscal years available, as well as a high-level overview and status update on the state’s delivery system reform efforts. The 2019 chart pack features a summary of the program’s impacts on access to care and health outcomes and new data highlighting the role of MassHealth in supporting the low-income workforce. The chart pack provides comprehensive yet accessible data points and updates on the complex MassHealth program that will be useful to policymakers and administrators, as well as advocates and academics.

Some of the key information from the 2019 chart pack -- which is organized under three sections, Eligibility and Enrollment, Spending and Cost Drivers, and Reforms -- includes:

  • MassHealth enrollment has been relatively stable for the past four years (2015-2018), hovering just above 1.8 million members. Notably:
    • More than 4 in 10 children in Massachusetts are MassHealth members; and
    • More than three quarters of non-elderly MassHealth members live in working families.
  • MassHealth represents a significant portion of the state budget, but the majority of its spending is paid for with federal funding, and spending growth has moderated in recent years as enrollment has leveled off.
    • From 2013-2016, prescription drugs and home- and community-based long-term services and supports (LTSS) were the key drivers behind per-enrollee spending growth in MassHealth.
  • MassHealth’s delivery system reform changes are well underway. Status updates are included on major initiatives:
    • Newly formed Accountable Care Organizations, which began full operation in March 2018, now have over 890,000 MassHealth members enrolled.
    • Launch of the Community Partners and Flexible Services programs to improve integration of behavioral health, LTSS, and social services.
    • Expansion of coverage for outpatient, residential inpatient, and community services to combat the substance use disorder crisis.

The chart pack is made available in PDF and PowerPoint formats to facilitate its use in presentations. A webinar to review this updated chart pack was held on October 29, 2019. A recording of that webinar is available here.

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