Baker-Polito administration, Centers for Medicare and Medicaid Services announce MassHealth

The Baker-Polito Administration received federal approval for its five-year Medicaid (MassHealth) 1115 waiver. The Centers for Medicare and Medicaid Services-approved waiver supports the restructuring of the MassHealth program to provide integrated, outcomes-based care to 1.9 million Massachusetts residents. 

The waiver provides the opportunity for Massachusetts to move from its current fee-based model to a system of Accountable Care Organization models (ACO) who work in close partnership with community-based organizations to better integrate care for behavioral health, long-term services and supports and health-related social needs.

Without the waiver, Massachusetts would have lost $1 billion a year in federal funds starting July 1, 2017. The new waiver, which is effective July 2017, authorizes $1.8 billion over five years of new Delivery System Reform Incentive Program (DSRIP) funding to support the move to ACOs, invests in Community Partners for behavioral health and long term services and supports, and allows for innovative ways of addressing the social determinants of health. It also authorizes and sustains nearly $6 billion of additional safety net care payments over five years to hospitals and the health safety net for the uninsured and underinsured, and for subsidies to assist consumers in obtaining coverage on the Massachusetts Health Connector.

The waiver also authorizes MassHealth to launch an ACO pilot program beginning December 2016. The ACO pilot program will transition MassHealth from the current fragmented, fee-for-service care model towards accountable care and population-based payments with selected ACOs under an alternative payment methodology that includes shared savings and risk.

The Massachusetts waiver restructures the current MassHealth delivery system in a manner that promotes integrated, coordinated care and holds providers accountable for quality and total cost of care of its members.

The waiver also expands access to a broad spectrum of recovery-focused substance use disorder services, in an effort to address the opioid addiction crisis.

Officials aim to sustainably support safety net providers to ensure continued access to care for Medicaid and low-income uninsured individuals. The waiver expands the number of safety net hospitals eligible for reimbursement for uncompensated care from seven to 15.

Massachusetts has the highest rate of insured residents in the U.S., with an uninsured rate of fewer than three percent. Officials expect the waiver to help them maintain near-universal health insurance coverage.