This updated edition of the tracking tool provides a detailed description of key components of Chapter 224, highlighting the progress the state has made in its implementation of the law as of August 2015. This tool is designed for policymakers, advocates, and other stakeholders who wish to track when and how state leaders have addressed policy issues pertaining to Chapter 224.

This tracking tool is a living document and will be updated annually. If you have any suggested additions or corrections, please email [email protected].

In March 2010, President Obama signed The Patient Protection and Affordable Care Act (ACA), which included significant changes impacting health insurance coverage across the United States. Although many elements of the ACA were based on Massachusetts’ health insurance reform, there were still many decisions and activities that Massachusetts needed to address in order to comply with the new federal Medicaid and health insurance marketplace requirements, most of which were required to be effective as of January 2014. This issue brief, prepared by Health Management Associates, focuses on the changes in eligibility, benefits, cost sharing (including premiums), and health plan options available to individuals receiving subsidized insurance in the Commonwealth before and after implementation of the ACA.

This budget brief highlights the fiscal year (FY) 2016 budget for MassHealth (Medicaid) and other subsidized health coverage programs. It is the last 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.

The “ Making Health Care Affordable” (MHCA) three-year grant program concluded in 2014. Margaret Houy and Kate Bazinsky of Bailit Health Purchasing, LLC report on the impact of the BCBSMA Foundation’s funding initiative. The goal of MHCA was to fund interventions aimed at containing costs while increasing access and quality of care. Bailit examines how the Foundation’s objectives were met, what factors led to successful program implementation, common barriers faced by grantees, and which programs may have generalizability.

UPDATED (July 2015) chart pack, prepared by the Center for Health Law and Economics at the UMass Medical School, includes summary data on MassHealth enrollment and spending and is designed to support use of the charts in presentations. Updated edition includes MassHealth enrollment as of March 2015 and spending from state fiscal year 2014.

Social determinants of health, which encompass social, behavioral and environmental influences on one’s health, have taken center stage in recent health policy discussions. While research indicates that greater attention to these non-medical factors may improve health outcomes and reduce health care costs, translating this evidence into actionable recommendations for policy makers and others has been challenging. This report, prepared by a team led by Elizabeth Bradley of the Yale Global Health Leadership Institute and Lauren Taylor of the Harvard Divinity School, evaluates and synthesizes the evidence base for interventions that address social determinants of health, with special attention to innovative models that may improve health outcomes and reduce health care costs and that may be applicable in the Massachusetts policy context. Based on this review, there is strong evidence that increased investment in select social services (e.g., housing support and nutritional assistance), as well as various models of partnership between health care and social services (e.g., integrated health care and housing services), can result in substantial health improvements and reduced health care costs for targeted populations.

This report, prepared by Sharon Long and Thomas Dimmock of the Urban Institute, further analyzes the 2013 Massachusetts Health Reform Survey (MHRS) by comparing the experience of adults with public coverage to adults with employer-sponsored insurance (ESI) coverage across a number of access and affordability measures. Findings from the analysis show problems with access to care were more prevalent for adults with public coverage than for those with ESI. These disparities persist even after controlling for variations in health care needs and socioeconomic status between the two groups. The persistence of gaps in access to care for adults with public coverage raises concerns about systemic barriers to care within the Massachusetts health care system.

In conjunction with the full report, the authors developed a one-page summary highlighting key findings from the analysis.

This report, prepared by Margaret Houy and Michael Bailit of Bailit Health Purchasing, LLC, provides a comprehensive review of the policy and regulatory barriers that impede behavioral health integration in Massachusetts and identifies potential options for addressing these barriers. This report is divided into three sections – licensing, privacy, and, reimbursement barriers – and was developed through a review of reports and other secondary sources, agency regulations and checklists, and interviews and a focus group with key stakeholders. Incorporating the input from the focus group, it concludes with a discussion of the top three priorities that, if addressed, would have the most significant impact on removing barriers to integration. This report is intended to serve as a resource summarizing key issues and potential opportunities for policymakers to improve the integration of physical and behavioral health care services.

This brief describes the Massachusetts Senate fiscal year (FY) 2016 budget proposal for MassHealth (Medicaid) and other subsidized health coverage programs and compares it to the proposal put forth by the House. It is the third 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.

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.

In 2014, the Foundation partnered with the city of Boston to conduct a thorough analysis of the scope of Boston's substance use addiction problem and selected DMA Health Strategies to conduct the research. With the Mayor’s Office, the Foundation also assembled an Addiction Recovery Advisory Group comprised of addiction experts and community stakeholders to work closely with the researchers. This report, which focuses on how to better align the city of Boston’s addiction and recovery services with demonstrated best practices, will serve as a roadmap for the Mayor’s Office of Recovery Services.

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.

In this report, Carol Gyurina, Jennifer Rosinkski and Robert Seifert of the University of Massachusetts Medical School, analyze several factors that help explain why health care affordability continues to be a challenge in Massachusetts, even after achieving near universal health insurance coverage. Beginning with an analysis of data largely collected through the Massachusetts Health Reform Survey (MHRS), the report provides an overview of the factors influencing health care affordability and summarizes the financial and access to care consequences for consumers struggling with health care costs. The remainder of the report is devoted to sharing the personal stories of four individuals in Massachusetts who have experienced first-hand the challenges and consequences of unmanageable health care costs.

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.