This brief describes the potential impact in Massachusetts of a proposed rule, released by the Department of Homeland Security in October 2018, to change the process by which it determines whether an immigrant is inadmissible to the United States or unable to adjust status because the person is likely to become a “public charge.” The proposed Public Charge Rule would mark a significant shift from current policy by defining a “public charge” as a noncitizen who receives one or more public benefits. This brief also provides an estimate of the scope of immigrants in Massachusetts who may be impacted by the proposed rule and what effect that could subsequently have, both directly and as a result of the “chilling effect,” on enrollment in particular benefit programs, including MassHeath and the Children’s Health Insurance Program (CHIP).

In Massachusetts, MassHealth is implementing a number of reforms as part of its most recent Medicaid 1115 demonstration waiver extension to transform the delivery of care for most members and address the social determinants of health (SDOH). In light of the new interface between health care and social service delivery fostered by the MassHealth program redesign, it is important to understand how community-based organizations (CBOs) perceive the entry of health care organizations into their domains of social service delivery. While health care providers’ perspectives are frequently reported on, less is known about how CBOs view the opportunities and challenges associated with these new relationships.

This report aims to address this knowledge gap by summarizing the findings from a qualitative study that sought to better understand how CBOs are responding to the health care sector’s movement into SDOH programming in Massachusetts. Data was collected through 46 key informant interviews with CBO representatives from a range of social service sectors across the state. Informed by the study findings, this report outlines recommendations for health care leaders and policymakers to support the integration of health care and social service delivery.

This report seeks to inform the discussion of MassHealth sustainability through a novel analysis of MassHealth data that differentiates among the major drivers of MassHealth spending. The report examines whether spending is being driven by growth in enrollment or per-enrollee spending, and which populations or types of services are the biggest contributors to spending growth. The findings suggest that as enrollment growth tied to previous coverage expansions levels off, the state will increasingly need to focus on controlling per-enrollee spending, particularly in the areas of pharmacy and long-term services and supports (LTSS).

Following a review of the findings, this report proposes a series of tailored policy options informed by other states’ strategies to further understand and address spending growth in the areas of pharmacy and LTSS.

MassHealth introduced accountable care organizations (ACOs) for many of its members in March 2018. An ACO is a group of doctors, hospitals, and other health care providers that work together with the goals of delivering better care to members, improving the population’s health, and controlling costs. This brief serves as a resource for stakeholders (i.e., providers, health care administrators, policymakers) to help explain the key elements of MassHealth ACOs. A variety of topics are covered in this brief, including: member eligibility; ACO types; savings and losses; member enrollment and assignment; plan selection periods and fixed enrollment; primary care provider exclusivity; and ACO features, such as community partners.

This brief frames the key issues and potential impacts to Massachusetts consumers that may result from implementation of the federal proposed rule to expand the availability of Association Health Plans (AHPs). This brief:

• Describes the ways in which allowing AHPs to operate according to the proposed rule could impact the scope of benefits, provider networks, and consumer protections available to consumers in plans covered through this arrangement;
• Explains technical topics such as risk segmentation and rating rules and why they are important in considering the impacts of the proposed AHP rule on consumer access to health coverage; and
• Provides policymakers with options the Commonwealth could consider to protect consumers in response to the federal AHP proposal.

This brief provides an overview of the steps that Massachusetts has taken to establish a functioning insurance market that provides consumers with meaningful access to health coverage. It includes a review of statutory and regulatory provisions in place today, and provides context for key health reform initiatives that have occurred over the past 30+ years. This brief is structured around four key components of a functioning market for health coverage:

1. Encouraging or requiring coverage of a comprehensive set of benefits and services;
2. Ensuring fair competition among insurance carriers;
3. Providing access to coverage, particularly for low- and middle-income residents; and
4. Instituting mechanisms to protect consumers.

The policies and provisions described in this brief have played an important role in the evolution of the Massachusetts market, helping the state achieve near-universal coverage, enabling most Massachusetts employers to offer comprehensive coverage to their employees, establishing a competitive market for health coverage, and protecting consumers.

Given the impact that social factors have on health status and expenditures, and the shift toward value-based payment models that reward providers based on outcomes, health care organizations (HCO) and community-based organizations (CBO) across the country are increasingly working together to address patients’ social needs. In Massachusetts, MassHealth is investing in accountable care organizations and community partners to integrate physical health, behavioral health, and long-term services and supports and also funding certain approved “flexible services” that address health-related social needs that are not otherwise covered as MassHealth benefits.

Based on a review of promising HCO-CBO partnership models, this brief outlines characteristics of effective HCO-CBO partnerships and provides recommendations to guide the development of successful collaborations between health care and social service organizations. 

This brief prioritizes issues for consideration as accountable care organizations (ACOs) and managed care organizations (MCOs) prepare to integrate and fully manage comprehensive long-term services and supports (LTSS) over the course of Massachusetts’ five year 1115 waiver extension. The identified priority areas were informed by lessons learned from managed LTSS programs in other states and interviews with key stakeholders in Massachusetts. This brief concludes with a series of detailed descriptions of the institutional and community LTSS covered under the Medicaid state plan that will eventually be integrated into ACOs and MCOs.

Based on valuable feedback from stakeholders this brief has been revised to better distinguish between certain services, in particular, adult foster care and group adult foster care.

This series of reports describes the results of a comprehensive mixed-methods study, Access to Outpatient Mental Health Services in Massachusetts. The study sought to quantify the wait times for outpatient mental health office visits in Massachusetts, better understand the experiences of clients seeking an appointment, and identify facilitators and barriers to accessing mental health services. Study findings are based on primary data from multiple sources, including qualitative data from stakeholder interviews and client focus groups and quantitative data from surveys of clinicians and administrators at organizations providing outpatient mental health services.

Findings from this study were featured at a Foundation event held on October 31, 2017. Click here to learn more about the event.

Federal authorization for the Children’s Health Insurance Program (CHIP) expired on September 30, 2017. Senators Orrin Hatch (R-UT) and Ron Wyden (D-OR) have filed a bill to extend CHIP for five years, but Congress did not act quickly enough to prevent the current authorization from expiring. Unspent federal CHIP funds may be carried over into the next fiscal year and Massachusetts’s current allotment of federal CHIP funds should allow the state to continue to use CHIP funds for benefits until early 2018. However, we have now entered a policy limbo in which states are hopeful for reauthorization but must also determine other coverage options for children if funds run out.

As follow up to the Foundation’s June report, The Importance of CHIP Reauthorization for Massachusetts, this brief provides an update on the status of federal reauthorization for CHIP and a summary of its potential impact on the program in Massachusetts.

This primer is designed to increase understanding of the behavioral health care system in Massachusetts and the issues affecting access to care for individuals with mental health and substance use disorders. It is intended to serve as a foundation for future work focused on behavioral health system solutions.

This resource provides a brief background on the state’s behavioral health system, a historical overview of policy changes that have affected access to behavioral health care, and a review of prevalence data highlighting trends in mental health and substance use disorders. The remaining sections present state specific data on four primary factors affecting access to behavioral health care: 1) workforce capacity; 2) system capacity; 3) affordability; and 4) quality. This primer concludes with a review of the gaps in available data on these topics and behavioral health care generally, which limits the ability to provide a comprehensive account of the behavioral health system and client access.

This report describes the Children’s Health Insurance Program (CHIP) in Massachusetts and its role as part of MassHealth. Though there is no expiration date for CHIP in federal law, Congress has authorized funding of the program through September 30, 2017. Without Congressional action, a majority of states, including Massachusetts, will exhaust their current federal CHIP allocation by March 2018. This report discusses the importance of CHIP and the broader health policy debate, including reauthorization, now taking place in Washington.

The Blue Cross Blue Shield of Massachusetts Foundation, on behalf of the Massachusetts Coalition for Coverage and Care, funded a state-level analysis on the impact of the American Health Care Act (AHCA) on Massachusetts focused on 2022, when the law would be fully phased in.

Created by the Urban Institute’s Health Policy Center, this analysis uses state-level cost and coverage data from MassHealth (the state’s Medicaid program), the Massachusetts Health Connector Authority, and the Center for Health Information and Analysis. It is believed to be the first published study of the bill’s impact on an individual state.

This report presents the results of a study analyzing the impact of the Community Support Program for People Experiencing Chronic Homelessness (CSPECH) on the utilization and cost of health care services. CSPECH is an innovative program through which MassHealth reimburses community-based support services provided to chronically homeless individuals residing in permanent supportive housing. Findings show that coupling supportive services like the type provided by CSPECH with permanent housing can lead to substantial improvements in housing stability and significant reductions in the utilization of acute health care services.

Findings from this report were featured at a Foundation event held on March 8, 2017. Click here to learn more about the event.

This issue brief describes the key elements of the most recent MassHealth 1115 waiver extension, including the shift to a delivery system centered on Accountable Care Organizations and Community Partners, a Delivery System Reform Incentive Program, the redesigned Safety Net Care Pool, and the expansion of services for treatment of substance use disorders. It concludes with a discussion of implications of the new system for major stakeholder groups.