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. In December 2022, Congress passed the Consolidated Appropriations Act, 2023 which established March 31, 2023 as the end date of the continuous coverage requirement.

Since the federal continuous coverage requirement will expire at the end of March, MassHealth is preparing to redetermine eligibility for all members starting April 1, 2023. As MassHealth begins to redetermine eligibility for a considerable volume of members, there is a risk that some individuals who remain eligible for coverage could become uninsured. This issue brief includes a summary of MassHealth’s eligibility and enrollment approach for when it resumes normal eligibility and redetermination processes and describes strategies that MassHealth and other stakeholders are taking to ensure that people who remain eligible stay covered.

Massachusetts’ historical achievements in bold and innovative health care policy have positioned the state as a national leader in transforming health care coverage, access, affordability, and quality. Yet despite decades of progress, the COVID-19 pandemic made it impossible to ignore that not all Massachusetts residents are able to access, afford, or experience health care equally.

In early 2022, anticipating the election of a new governor and slate of legislative leaders, the Blue Cross Blue Shield of Massachusetts Foundation in partnership with Manatt Health solicited perspectives on health reform priorities from a broad and diverse group of health care stakeholders, including consumer, provider, health plan, business, and labor representatives. This report synthesizes the findings from these stakeholder interviews, describing five health care priorities for the new governor and legislative leaders to immediately pursue: 1) addressing systemic racism and inequities in health; 2) ensuring consumer affordability of health care; 3) confronting the mental health crisis for children and youth; 4) improving the affordability of and access to long-term services and supports (LTSS); and 5) solving severe health care workforce shortages, particularly in the paraprofessional LTSS and behavioral health workforce.

The report explores each theme in detail and identifies specific action steps incoming state leaders can take to address these challenges. An accompanying executive summary and infographic provide a high-level overview that can be used by a wide audience. 

The behavioral health workforce in Massachusetts is in crisis. The COVID-19 pandemic has increased the prevalence of behavioral health issues and demand for services, exposing and aggravating the vulnerabilities of Massachusetts’ behavioral health workforce and delivery system. Health care, including behavioral health care, has been among the industries hardest hit by the “Great Resignation,” exacerbating workforce shortages that predated the pandemic. These dynamics fuel an urgent call to action for Massachusetts to grow and support a workforce that can meet the pressing demand for behavioral health care in the Commonwealth. Informed by a literature review, the development of an inventory of promising models nationwide, and interviews with local and national stakeholders and experts, this report outlines seven concrete recommendations to expand Massachusetts’ behavioral health workforce, increase its diversity, maximize its potential to meet the needs of all people in the Commonwealth, and strengthen its resilience.

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. While this request largely aims to continue and improve upon the programs and initiatives that are a part of the current Demonstration, an area of specific focus within the proposed extension centers around advancing health equity within the MassHealth program. As part of this request, MassHealth seeks to promote health equity by both building on current program elements and introducing new strategies such as investing in certain populations that experience persistent health inequities and creating incentives for ACOs and hospitals to measure and reduce health inequities.

This report describes the proposed MassHealth Demonstration extension, what it means for MassHealth coverage moving forward, and implications for members, providers, and other stakeholders.

The Foundation has committed to base its work in the structural racism and racial inequities in health focus area on issues raised by the communities and community members experiencing racism and health inequities. To that end, the Foundation partnered with established community-based organizations across the state to convene focus groups featuring the perspectives of community members on how racism impacts health and access to health care services. A total of seven focus groups, organized geographically, were held virtually. At each focus group, a total of eight to ten individuals participated, representing three to four organizations in each region. Focus group participants were selected based on the alignment of their organization’s work with the Foundation’s mission and focus areas.

The key themes that emerged related to two forms of racism: (1) racial bias in clinical care, which plays a key role in poor health outcomes for individuals and communities of color and (2) the policies and practices of health care systems and the legal and regulatory climate. The report summarizes those themes and presents recommendations, which include guidance for the types of programs and services that need support in communities, direction for the Foundation’s policy work, and considerations for grantmaking programs and processes.

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 response to the COVID-19 crisis in 2020. As a condition of receiving these funds, Massachusetts is required to maintain continuous coverage in MassHealth during the federal COVID-19 public health emergency. When the continuous coverage requirement expires at the end of the month in which the public health emergency ends – which is currently slated for July 14, 2022 – MassHealth will resume its standard renewal, or “redetermination,” processes. As MassHealth begins to redetermine eligibility for a considerable volume of its members, there is a high risk that some individu­als who remain eligible will experience a loss in coverage. This brief includes a summary of MassHealth’s eligibility and enrollment approach for when it resumes normal eligibility and redetermination processes and describes additional strategies that MassHealth and other stakeholders can take to ensure that people who remain eligible stay covered.

In December 2021, Governor Baker signed Chapter 102 of the Acts of 2021 into law. This legislation, often referred to as the “ARPA bill,” appropriates close to $4 billion, including $2.55 billion in funding directly from the federal American Rescue Plan Act (ARPA). ARPA was passed in March 2021 to provide money to states to start recovering from the effects of the COVID-19 pandemic. Chapter 102 invests money from ARPA in many areas, including housing, infrastructure, education, and economic development. Health services received $950 million in the law, with funding for physical health, behavioral health, long-term care services, and public health initiatives. This issue brief summarizes the key components of Chapter 102 that will affect health and health care in Massachusetts.

The goal of this study was to better understand whether Primary Care Providers (PCPs) identify a need for a PCP-to-behavioral health (BH) provider consultation program for adult patients with mental health conditions and substance use disorders (SUDs), and whether they would utilize such a program. Additionally, the study sought to understand the type of BH conditions providers encounter, the proportion of adult primary care patients with BH needs, and the challenges PCPs face in supporting adult patients with BH conditions. These findings are intended to help stakeholders understand how a consultation program might be best structured to provide evidence-based support to PCPs and, in turn, their patients with BH needs.

This brief provides an updated snapshot of the need for behavioral health care and experiences accessing it in the Commonwealth as of 2020/2021, based on a new survey commissioned by the Foundation.  This survey was fielded by NORC at the University of Chicago between December 2020 and March 2021 and gathered information on the need for and access to behavioral health care among Massachusetts adults ages 19 and older and their close relatives. The survey gathered information on the experiences of Massachusetts adults during the 12 months prior to the survey, which covered the period January 2020 through March 2021. Given the timing of the survey and its 12-month look-back period, the survey collected information over roughly the first year of the COVID-19 pandemic. The survey also included a series of questions focused explicitly on the link between the COVID-19 pandemic and the need for behavioral health care.

This primer serves as a foundational resource to broaden the collective understanding of racial and ethnic health inequities and disparities in the Commonwealth as part of our new focus area of Structural Racism and Racial Inequities in Health. The primer is intended to support discussion about how our health care system and other systems that impact health enhance or undermine health, and to facilitate the development of solutions to strengthen those systems to serve all Massachusetts residents.

The primer presents a data-informed reflection of the racial and ethnic health inequities and disparities Massachusetts residents confront today. It offers a basis for further discussion and action, including to evolve and improve the data resources that shed light on racism and racial inequities in Massachusetts’ social and health care systems. The Foundation’s work in this focus area will aim to identify and elevate health care policies and practices that will advance health equity and reduce health disparities in the Commonwealth.

To the extent possible in the confines of a data-focused report, the primer acknowledges critical context about the historical and structural contributors to the racial and ethnic health inequities and disparities that exist today. Data limitations and gaps are noted throughout, identifying where new or improved data is needed to provide a comprehensive, cohesive, and actionable set of data to support the Commonwealth’s health equity goals.

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. This brief looks beyond the budget totals to help stakeholders better understand the actual state cost of MassHealth by accounting for the state and federal partnership that finances this program.

In state fiscal year (SFY) 2022, the state projects it will spend approximately $19.2 billion on MassHealth. This total (or “gross” amount) is approximately 36 percent of total estimated state spending for SFY 2022. 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 $8.5 billion or 22 percent of the total state spending in SFY 2022. 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.

In response to the health and economic damage caused by the COVID-19 pandemic, Congress passed the American Rescue Plan Act (ARPA) in March 2021, which makes $1.9 trillion available to individuals, states and territories, counties, cities, community organizations, educational institutions, and other entities. Some funds are intended to shore up or even expand programs and agencies that have been depleted during the pandemic, while other funds are designated or available to create new programs. ARPA contains many health-related provisions, with particular focus on behavioral health services (inclusive of mental health and substance use care), the health care workforce, and programs that make health insurance coverage and health care available to more people. This summary focuses on the key components of ARPA that will affect health care in Massachusetts.

Health care payers, providers, and policymakers are increasingly pursuing value-based payment (VBP) to improve the quality of care and population health while controlling rising health care costs. When implemented in Medicaid, VBP programs often include children and adults in the same model, though these models may not fully account for children’s distinct health needs.

This report seeks to inform the work of Massachusetts policymakers and stakeholders to better incorporate children’s health needs and experiences within the payment models in the MassHealth Accountable Care Organization (ACO) Program by examining lessons from states and providers throughout the country.  Based on the results of an environmental scan, including a review of peer-reviewed and gray literature and interviews with 18 subject matter experts, this report identifies and describes four main VBP approaches for delivering care to pediatric populations. The authors then synthesize key themes and lessons learned for successfully implementing VBP models for children. These findings suggest there is great opportunity for Massachusetts to serve as a leader in this field, and the report lays out a set of policy and program considerations to help Massachusetts design an approach to better serving children within and alongside the framework of the existing ACO Program. Ultimately, adapting VBP for pediatric populations requires recognition that pediatric VBP models should not be focused on short-term savings but rather on improving quality of care to support child health and long-term population health outcomes.

Addressing timely access to behavioral health care through the adoption of open access methods supports the well-being of people with behavioral health conditions, improves staff productivity, and increases financial stability for provider organizations. However, no study has previously documented the experience of provider organizations using this model in Massachusetts.

The report identifies organizations that operate open access today and highlights the approaches that have been most successful. The report also pinpoints keys to success for organizations to consider in adopting an open access model and offers policy recommendations to promote the broader adoption of open access in the Massachusetts behavioral health care system.  The case studies provide detailed descriptions of each model, describe the successes and challenges of implementation, and indicate how COVID-19 has impacted operations.

This five-part series of issue briefs describes MassHealth’s impact on the health and finances of its members, families, and communities, as well as on the wide variety of stakeholders and sectors outside of the traditional health care realm that benefit from the program, including:

• the Commonwealth’s schools and school‐aged children, teens, and young adults;
• the state’s economy and businesses, including how MassHealth supports working families, reduces uncompensated care costs, and draws federal funds into the state;
• the behavioral health care system, addressing how MassHealth provides coverage, access, and delivery of services across the full behavioral health care continuum; and
• justice-involved persons, describing how MassHealth supports re-entry into the community.

Key findings from this series were featured at a Foundation virtual event on Wednesday, June 30^th from 2:00-4:00 pm. Click here to view event materials.