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.

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.

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.

On October 18, 2019, Governor Charlie Baker submitted House Bill 4134, An Act to Improve Health Care by Investing in Value, to the Massachusetts Legislature. The bill proposes a comprehensive set of policies designed to address barriers to behavioral health care access, including the establishment of a new system that would incentivize providers and health plans to spend more of their funds on primary care and behavioral health services while rebalancing spending in other areas. This brief provides a summary of the provisions of the bill that specifically target behavioral health care delivery and access.

Since the Governor’s bill was filed, the state Senate has passed Senate Bill 2519, An Act Addressing Barriers to Care in Mental Health, which similarly includes several provisions intended to improve access to mental health care. The Senate’s summary of the bill is available here.

Texas v. United States, a case currently before the U.S. Court of Appeals for the Fifth Circuit, seeks to overturn the Affordable Care Act (ACA). The court’s decision in the case could be announced any day and the case may ultimately be decided by the Supreme Court. A final ruling that overturns the ACA would have widespread implications, affecting every state in the nation.

This brief describes the implications of repeal for Massachusetts — focusing on what it could mean for the state’s health insurance coverage rates and federal funding, and what conditions would be necessary to prevent a significant erosion of Massachusetts’ coverage gains if the courts were to overturn the ACA. Two main scenarios are described: 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 were generated from a model developed by the Urban Institute using state-level 2019 cost and coverage data from MassHealth, the Massachusetts Health Connector, and the Center for Health Information and Analysis.

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 brief and accompanying set of tables serve as an update to previously released reports on the geography of uninsurance in Massachusetts. Relying on newly released data for 2013-2017 from the American Community Survey (ACS), this brief uses three measures of uninsurance – uninsurance rate, number of uninsured, and concentration of uninsured – to identify high-uninsurance communities in the state. This brief also provides new information on socioeconomic characteristics of high-uninsurance communities and their uninsured residents to further inform strategies for targeted outreach efforts. Among other key findings, by looking at the concentration of uninsured residents (i.e., the number of uninsured per square mile of land area) to identify high-uninsurance communities, we find that the uninsured are concentrated in a relatively small number of communities, primarily in and around Boston.

Included with this release is a set of detailed tables available for download that provide estimates of the rate and number of uninsured for all persons, children (ages 0-18), and adults (ages 19-64), by various geographic units, including Congressional districts, counties, cities and towns, and census tracts.

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.

In January 2016, the Blue Cross Blue Shield of Massachusetts Foundation undertook a three-year grant-funded initiative to expand access to integrated behavioral health (IBH) and primary care services in Massachusetts – Fostering Effective Integration (FEI). Grants were awarded to a diverse cohort of eight providers in the Commonwealth with experience in delivering IBH care. This report describes the findings of an evaluation conducted by John Snow, Inc. (JSI) from January 2016 to December 2018. The evaluation results shed light on the impact of various models of IBH on access, outcomes, and cost depending on population and setting. Further, through the testing of innovative models of IBH care, the FEI evaluation describes several substantial lessons learned regarding:

• Linkages to primary care for patients with severe mental illness whose main point of contact with the health system is the behavioral health system;
• Strong engagement in IBH services and intensity of service use by adolescents;
• Improved access to behavioral health care for an older population; and
• Improved capacity to collect and use quality improvement data.

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 report and companion chart pack document and describe the current behavioral health (inclusive of mental health and substance use disorder) care system for children, adolescents, and adults in Massachusetts; outline a new whole-person-oriented vision for behavioral health care in the Commonwealth; and propose a strategic approach and series of recommendations through which the state can advance this vision to achieve reform. This new vision for behavioral health care in Massachusetts addresses some of the most pressing challenges impacting how behavioral health care is delivered today. Among others, these include: barriers to accessing and navigating the behavioral health care continuum, inadequate coverage of behavioral health care services across payers, workforce shortages and capacity issues, unnecessary regulatory burden and redundancy, fragmented administrative and payment functions, and lack of monitoring and accountability for behavioral health outcomes.

To develop this new vision, researchers interviewed and facilitated discussion groups with state and national behavioral health experts, stakeholders, and thought leaders, and conducted a comprehensive landscape scan of the current public and private behavioral health care system in Massachusetts. Researchers identified the system’s many strengths and persistent weaknesses and then constructed a “model” system to guide the new vision.

Findings from this report were featured at a Foundation event held earlier today. Click here to learn more about the event.

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).