California v. Texas, a case currently before the U.S. Supreme Court, seeks to overturn the Affordable Care Act (ACA). The court is expected to begin hearing arguments on this case on November 10, 2020. A final ruling that overturns the ACA would have widespread implications, affecting every state in the nation.

This brief and companion infographic describe what’s at stake for Massachusetts if the court were to overturn the ACA — focusing on what it could mean for the state’s health insurance coverage rates and federal funding. This analysis is based on two scenarios: 1) where the ACA is overturned in its entirety and the state is not able to reestablish the subsidized coverage programs created by the state’s 2006 health reform and 2) where the ACA is overturned, but the state is able to reestablish its 2006 coverage programs.

The estimates described in this brief are generated from a model developed by the Urban Institute, which was used for a similar analysis released by the Foundation in December 2019. This new analysis uses state-level 2019 and 2020 cost and coverage data from MassHealth, the Health Connector, and the Center for Health Information and Analysis. The updated data used for this analysis captures many of the changes to the health insurance coverage landscape in Massachusetts as a result of COVID-19 and the associated economic downturn.

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.

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.

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.

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.

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 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 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.