Medicaid

This UPDATED (October 2024) edition of the MassHealth: The Basics chart pack provides new data on MassHealth enrollment and spending from the most recent state fiscal years available. The chart pack features a high-level overview of the delivery systems that serve MassHealth members. It also highlights MassHealth’s latest reform efforts, which include initiatives to advance health equity, to expand services and coverage to certain groups, and to improve timely access to behavioral health care.

NOTA: Este informe también está disponible en inglés. Consulte nuestra página de inicio en español para este informe aquí. 

NOTE: This report is also available in English. Click here to view the report in English.

In 2013, Massachusetts launched One Care, an integrated care program that serves dual eligible individuals with disabilities age 21 to 64 (at the time of enrollment). One Care aims to coordinate Medicare and Medicaid benefits, streamline services and financing through a single health plan, and help its members live independently and thrive in the community. The program serves around 42,000 dual eligible members in Massachusetts.

In early 2023, Massachusetts began implementing its Roadmap for Behavioral Health Reform (Roadmap), a sweeping set of changes aimed at simplifying access and entry to the state’s outpatient behavioral health care system for all Massachusetts residents. The Roadmap reforms are designed to address challenges with the current behavioral health care system, including difficulty finding community-based providers and culturally relevant services, a lack of integrated mental health and addiction treatment, and a continued reliance on the emergency department for crisis and acute care.

Recognizing that member input is essential for effectively improving health outcomes and advancing equity, MassHealth and other Medicaid agencies across the country are increasingly engaging with members to inform program and policy design. MassHealth currently employs a variety of approaches for soliciting member feedback on program design and policy changes, and has signaled its commitment to strengthening its member engagement approach.

This report aims to inform MassHealth’s efforts to strengthen its overall member engagement strategy. The report:

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.

Long term services and supports (LTSS) are the critical services and supports that people with disabilities and chronic conditions of all ages use to meet their daily living needs, remain independent, and participate in their communities.

Federal law requires states to recoup costs from certain Medicaid members’ estates – the money and possessions left after someone dies – if they received long-term services and supports (LTSS), such as care in a nursing facility or at home. But some states, including Massachusetts, exceed the federal minimum and recover the cost of all Medicaid-covered services that are provided to members over age 55. This means far more members are affected because it is not just limited to those who use LTSS.

MassHealth provides health care services to over 2 million Massachusetts residents. This updated infographic highlights key facts about MassHealth, including the many ways in which the program contributes to the Massachusetts economy and promotes health care coverage and access for residents in the state.

Peer supports are an important component of the health care system in Massachusetts. Peers provide a vital bridge to services by offering empathy, information, encouragement, and navigational assistance to people who face linguistic and cultural access barriers, stigma, absence of a support network, and other challenges. Peers are part of the communities they serve and often share lived experiences with the individuals they work with, making them uniquely qualified to foster trust in the health care system where it might be lacking.

MassHealth introduced Accountable Care Organizations (ACOs) in 2018 as an option for most of its members under age 65. As of June 2023, over 1.3 million members – more than half of MassHealth’s total membership – are enrolled in one of 17 MassHealth ACOs.

This report was developed as a resource for stakeholders to help explain the key elements of MassHealth ACOs, including the two types, who they serve, and the services they provide. It includes information on the following:

This UPDATED (October 2023) edition of the MassHealth: The Basics chart pack provides new data on MassHealth enrollment and spending from the most recent state fiscal years available. The chart pack features a high-level overview of the delivery systems that serve MassHealth members. It also highlights MassHealth’s latest reform efforts, which include initiatives to advance health equity and to improve timely access to behavioral health care.

Massachusetts has been exemplary in developing health insurance coverage policies to cover its residents. By 2019, the state’s uninsurance rate was 3.0 percent, the lowest rate in the nation, representing about 204,000 uninsured residents. While the state’s overall uninsured rate at a given point in time is low, more than twice as many people - 503,000, or 7.3 percent of the population - experienced a gap in coverage over the previous twelve months. And importantly, not all groups benefit equally.

This issue brief aims to educate stakeholders and policymakers about an upcoming federal policy change that could impact coverage for many MassHealth members. Like all states, Massachusetts received enhanced federal Medicaid funding under the Families First Coronavirus Response Act (FFCRA), the first major federal stimulus package passed by Congress in response to the COVID-19 crisis in 2020. As a condition of receiving these funds, Massachusetts was required to maintain continuous coverage in MassHealth during the federal COVID-19 public health emergency.

MassHealth provides health care services to over 2 million Massachusetts residents. This infographic highlights key facts about MassHealth, including the many ways in which the program contributes to the Massachusetts economy and promotes health care coverage and access for residents in the state.

This UPDATED (October 2022) edition of the MassHealth: The Basics chart pack provides new data on MassHealth enrollment and spending from the most recent state fiscal years available. The chart pack also features a high-level overview and status update on the state’s delivery system reform efforts, including a summary of the key elements of MassHealth’s latest 1115 demonstration waiver extension that was approved by the Centers for Medicare and Medicaid Services on September 28, 2022.

Massachusetts administers much of MassHealth through an 1115 Demonstration waiver, approved by the Centers for Medicare and Medicaid Services (CMS), which it has extended several times since it was originally approved in 1995. In December 2021, Massachusetts submitted a request to CMS to extend its Demonstration for another five years.

Massachusetts, with support from the federal government, has implemented several policy and programmatic changes intended to promote continued access to health care services and health insurance coverage during the COVID-19 public health emergency. This table serves as a centralized resource that documents and describes the policy, regulatory, and administrative actions pertaining to MassHealth, Health Connector programs, and the Health Safety Net.

An updated version of this issue brief is now available here.

This issue brief aims to educate stakeholders and policymakers about an upcoming federal policy change that could impact coverage for many MassHealth members.  Like all states, Massachusetts received enhanced federal Medicaid funding under the Families First Coronavirus Response Act (FFCRA), the first major federal stimulus package passed by Congress in resp