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.

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.

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.

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.

This brief describes the "net" state cost of MassHealth (determined by subtracting the federal reimbursement and similar revenues from the budgeted total), providing a much clearer picture of the impact of MassHealth on the state budget than state budget totals alone. It is a supplement to a series of FY2015 budget briefs produced by MMPI in partnership with the Massachusetts Budget and Policy Center.

One Care is Massachusetts’ demonstration project for adults with disabilities between the ages of 21 and 64 who are dually eligible for Medicare and Medicaid. October 1, 2014 marked the first year anniversary of the demonstration, which is slated to run through December 31, 2016. The Commonwealth of Massachusetts and the Centers for Medicare and Medicaid Services (CMS) have jointly contracted with three health plans to provide all medical, behavioral health, dental, pharmacy, and long-term support services covered by Medicare and Medicaid and any other services as determined by the member's care plan.

This fact sheet provides a comprehensive description of One Care. The November 2014 edition includes updated information on the risk sharing arrangement and a summary of the findings from the Early Indicators Project consumer survey. The infographic includes updated One Care enrollment by health plan, rating category and geography as of October 1, 2014. Also included is new data on disenrollment, rating category enrollment penetration and rating category enrollment within each One Care Plan. MMPI plans to update the enrollment infographic on a regular basis as new information becomes available.

This budget brief highlights the FY2015 budget for MassHealth and other subsidized health coverage programs. It is the last in a series of FY2015 budget briefs produced by MMPI in partnership with the Massachusetts Budget and Policy Center and the Massachusetts Law Reform Institute.

This budget brief compares the Massachusetts House of Representatives and the Massachusetts Senate Fiscal Year (FY) 2015 budget proposals for MassHealth (Medicaid) and other subsidized health coverage programs. It is the third in a series of FY 2015 budget briefs produced by the Massachusetts Medicaid Policy Institute (MMPI) in partnership with the Massachusetts Budget and Policy Center and the Massachusetts Law Reform Institute. MMPI will be publishing budget fact sheets at several stages in the FY 2015 budget process, as proposals move through the state legislature.

This brief describes the Massachusetts House of Representatives Fiscal Year (FY) 2015 budget proposal for MassHealth (Medicaid) and other subsidized health coverage programs. It is the second in a series of FY 2015 budget briefs produced by the Massachusetts Medicaid Policy Institute (MMPI) in partnership with the Massachusetts Budget and Policy Center and the Massachusetts Law Reform Institute. MMPI will be publishing budget fact sheets at several stages in the FY 2015 budget process, as proposals move through the state legislature.

UPDATED chart pack, prepared by the Center for Health Law and Economics at the UMass Medical School, including summary data on MassHealth enrollment and spending. Designed to support use of the charts in presentations. Updated edition includes MassHealth enrollment as of December 31, 2013 and spending from FY 2013.

This brief describes the Governor's Fiscal Year (FY) 2015 budget proposal for MassHealth (Medicaid) and other subsidized health coverage programs. It is the first in a series of FY 2015 budget briefs produced by the Massachusetts Medicaid Policy Institute (MMPI) in partnership with the Massachusetts Budget and Policy Center and the Massachusetts Law Reform Institute. MMPI will be publishing budget fact sheets at several stages in the FY 2015 budget process, as proposals move through the state legislature.