The goal of this study was to better understand whether Primary Care Providers (PCPs) identify a need for a PCP-to-behavioral health (BH) provider consultation program for adult patients with mental health conditions and substance use disorders (SUDs), and whether they would utilize such a program. Additionally, the study sought to understand the type of BH conditions providers encounter, the proportion of adult primary care patients with BH needs, and the challenges PCPs face in supporting adult patients with BH conditions. These findings are intended to help stakeholders understand how a consultation program might be best structured to provide evidence-based support to PCPs and, in turn, their patients with BH needs.

This brief provides an updated snapshot of the need for behavioral health care and experiences accessing it in the Commonwealth as of 2020/2021, based on a new survey commissioned by the Foundation.  This survey was fielded by NORC at the University of Chicago between December 2020 and March 2021 and gathered information on the need for and access to behavioral health care among Massachusetts adults ages 19 and older and their close relatives. The survey gathered information on the experiences of Massachusetts adults during the 12 months prior to the survey, which covered the period January 2020 through March 2021. Given the timing of the survey and its 12-month look-back period, the survey collected information over roughly the first year of the COVID-19 pandemic. The survey also included a series of questions focused explicitly on the link between the COVID-19 pandemic and the need for behavioral health care.

This primer serves as a foundational resource to broaden the collective understanding of racial and ethnic health inequities and disparities in the Commonwealth as part of our new focus area of Structural Racism and Racial Inequities in Health. The primer is intended to support discussion about how our health care system and other systems that impact health enhance or undermine health, and to facilitate the development of solutions to strengthen those systems to serve all Massachusetts residents.

The primer presents a data-informed reflection of the racial and ethnic health inequities and disparities Massachusetts residents confront today. It offers a basis for further discussion and action, including to evolve and improve the data resources that shed light on racism and racial inequities in Massachusetts’ social and health care systems. The Foundation’s work in this focus area will aim to identify and elevate health care policies and practices that will advance health equity and reduce health disparities in the Commonwealth.

To the extent possible in the confines of a data-focused report, the primer acknowledges critical context about the historical and structural contributors to the racial and ethnic health inequities and disparities that exist today. Data limitations and gaps are noted throughout, identifying where new or improved data is needed to provide a comprehensive, cohesive, and actionable set of data to support the Commonwealth’s health equity goals.

As a program that provides publicly-funded health benefits to more than 2 million low-income children and families, seniors and people living with disabilities in Massachusetts, it is not surprising that MassHealth accounts for a large share of the state’s budget.  However, a cursory review of the MassHealth budget can be misleading because it can obscure the billions of dollars in federal revenue that the program generates for the state. This brief looks beyond the budget totals to help stakeholders better understand the actual state cost of MassHealth by accounting for the state and federal partnership that finances this program.

In state fiscal year (SFY) 2022, the state projects it will spend approximately $19.2 billion on MassHealth. This total (or “gross” amount) is approximately 36 percent of total estimated state spending for SFY 2022. 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 $8.5 billion or 22 percent of the total state spending in SFY 2022. 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.

In response to the health and economic damage caused by the COVID-19 pandemic, Congress passed the American Rescue Plan Act (ARPA) in March 2021, which makes $1.9 trillion available to individuals, states and territories, counties, cities, community organizations, educational institutions, and other entities. Some funds are intended to shore up or even expand programs and agencies that have been depleted during the pandemic, while other funds are designated or available to create new programs. ARPA contains many health-related provisions, with particular focus on behavioral health services (inclusive of mental health and substance use care), the health care workforce, and programs that make health insurance coverage and health care available to more people. This summary focuses on the key components of ARPA that will affect health care in Massachusetts.

Health care payers, providers, and policymakers are increasingly pursuing value-based payment (VBP) to improve the quality of care and population health while controlling rising health care costs. When implemented in Medicaid, VBP programs often include children and adults in the same model, though these models may not fully account for children’s distinct health needs.

This report seeks to inform the work of Massachusetts policymakers and stakeholders to better incorporate children’s health needs and experiences within the payment models in the MassHealth Accountable Care Organization (ACO) Program by examining lessons from states and providers throughout the country.  Based on the results of an environmental scan, including a review of peer-reviewed and gray literature and interviews with 18 subject matter experts, this report identifies and describes four main VBP approaches for delivering care to pediatric populations. The authors then synthesize key themes and lessons learned for successfully implementing VBP models for children. These findings suggest there is great opportunity for Massachusetts to serve as a leader in this field, and the report lays out a set of policy and program considerations to help Massachusetts design an approach to better serving children within and alongside the framework of the existing ACO Program. Ultimately, adapting VBP for pediatric populations requires recognition that pediatric VBP models should not be focused on short-term savings but rather on improving quality of care to support child health and long-term population health outcomes.

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.

This budget brief highlights the state fiscal year (SFY) 2021 budget – which ran from July 1, 2020 through June 30, 2021 – for MassHealth and other health reform programs. The SFY21 budget was delayed by six months due to the COVID-19 pandemic and the resulting economic challenges and fiscal uncertainty. Included within the budget was $18.9 billion designated for health care coverage programs and related operational expenses. This brief provides an analysis of spending in the SFY2021 budget associated with MassHealth and other health care coverage and health reform activities, as well as a summary of new initiatives included in the SFY2021 budget that are expected to impact MassHealth program spending.

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

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.

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.

This resource highlights the most recent monthly enrollment data available for MassHealth and ConnectorCare — the two most prominent sources of publicly financed health insurance in Massachusetts. The compiled data and highlighted trends described in this resource are intended to help policymakers, health care stakeholders, and others track how enrollment in these programs has changed since the COVID-19 pandemic began affecting public health and the economy of the Commonwealth. This resource will be updated regularly with the latest enrollment data as it becomes available.

Stay up to date on the latest updates to this enrollment tracker by signing up for our email list.

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.

This educational brief describes the key elements of the Affordable Care Act (ACA) and provides an overview of California v. Texas, a case currently before the U.S. Supreme Court that seeks to overturn the ACA. Also included in this brief is a discussion of recent relevant case history and how the arguments in California v. Texas build upon prior legal challenges to the ACA.

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.