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 report, prepared by Manatt Health, lays out a vision for MassHealth long-term services and supports (LTSS) that is person-centered, integrated, sustainable, accountable, and actionable, providing Massachusetts policymakers with a set of options to consider when tackling some of the most intractable challenges facing the Commonwealth’s LTSS system.

The vision and policy areas addressed in the report were identified through the development of a data chart pack and supplemental interviews with consumers, government officials, community and institutional LTSS providers, health plans, and workforce representatives.

Findings from this report were featured at a Foundation event held on May 10, 2016, MassHealth Matters II: Options for Reforming Long-Term Services and Supports. Click here to learn more about the event.

This chart pack, prepared by Manatt Health Solutions, provides an examination of the current state of long-term services and supports (LTSS), an area identified as a priority for reform by MassHealth (Massachusetts Medicaid). MassHealth accounts for nearly half of all spending on LTSS, amounting to $4.5 billion annually, and equal to 12 percent of the state budget. Using previously unpublished LTSS data, the chart pack examines MassHealth LTSS spending and utilization, access and affordability, workforce capacity and quality. It also includes a summary of opportunities to improve delivery and coordination of LTSS.

Findings from this chart pack were featured at a Foundation event held on December 2, 2015, MassHealth Matters II: Long-Term Services & Supports (LTSS): Opportunities for MassHealth.

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.

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 report demonstrates how a general-operating-funds approach to grantmaking can forge stronger and more effective partnerships between the philanthropy and consumer health advocacy communities. It includes examples of the positive impact this approach has had on access to health care in Massachusetts and highlights some of the activities and achievements of 2011-2013 Strengthening the Voice for Access grantee organizations.

This report, written by Tony Dreyfus and Ellen Breslin Davidson of BD Group, provides an overview of the federal and state experience with risk adjustment in programs serving persons dually eligible for both Medicare and Medicaid.

Report summarizing the results of a series of interviews conducted by the Center for Health Care Strategies with key Medicaid stakeholders from across the country on cutting-edge Medicaid strategies including: purchasing strategies to optimize delivery systems; payment strategies to leverage existing funds; integrated models of care to improve services for complex populations; and opportunities for improved organizational capacity.

Comprehensive report presenting combined Medicare and Medicaid spending data for non-elderly adults (ages 21 to 64) dually eligible for Medicare and Medicaid in Massachusetts. This report was created by Ellen Breslin Davidson and Tony Dreyfus of BD Group. MMPI produced this report in collaboration with the Office of Medicaid in the Executive Office of Health and Human Services. Designed to support use of the charts in slide presentations.

Non-elderly people with disabilities comprise one-fifth of MassHealth enrollment and an even larger share of expenditures, yet their circumstances and the crucial role of Medicaid in financing essential services for them are not well understood. This comprehensive report seeks to promote such understanding and support informed policy discussions about this group.