A well-functioning health care system should provide affordable and timely access to needed health care for all residents, without regard to their race, ethnicity, income, zip code, age, gender, or sexual orientation. The Massachusetts health care system, despite many exemplary qualities, does not do this, and recent access, affordability, and equity challenges for individuals and certain population groups, such as people of color, have highlighted the shortcomings of a system that is determined largely by market forces and the decisions of private entities. Given the pressures on the current system, there is a renewed interest in exploring how the process of state health planning can improve the allocation of health care resources in service to access, quality, and affordability.

This issue brief offers background on health services planning, describing the concept and outlining its history, including its rise and fall in the United States and in Massachusetts. The bulk of the brief is a catalog of the regulatory and policy tools that Massachusetts uses today that incorporate some aspects of health services planning, and how these tools do and do not interact. The brief concludes with a discussion of the gaps Massachusetts needs to fill to realize a complete, comprehensive health services planning initiative.

The Foundation is hosting a webinar on Wednesday, May 28th from 11:00 AM – 12:00 PM with author, Robert Seifert, who will review key findings from the brief, which is intended to lay the groundwork for future research and analysis on state health planning. The webinar will also feature remarks from the Massachusetts Health Policy Commission focused on the recently enacted law that established the Office of Health Resource Planning, which as the name suggests, has a clear health planning mandate. Click here to register for the webinar.

This chart pack describes the potential threats to subsidized health insurance coverage and financing in Massachusetts under the new federal administration. The goals of this chart pack are to:

• Provide a high-level overview of MassHealth, the Health Connector, and publicly subsidized health insurance programs in Massachusetts that could be impacted by federal policy changes.
• Describe the potential changes in federal financing and policy related to Medicaid and subsidized Affordable Care Act Marketplace coverage programs that are likely being considered by the new federal administration.
• Provide estimates of the potential impacts of these changes (in terms of dollars or lives) for MassHealth and Massachusetts ConnectorCare programs.
• Identify, to the extent possible, the timing, political hurdles, and implementation vehicles for these potential changes.

On March 20, 2025, the Foundation hosted a webinar that featured a presentation of the chart pack’s content by its authors from Manatt Health. Click here to view a recording of this webinar.

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.

Are you interested in learning more about the MassHealth program? Were you unable to attend our November 2024 webinar on MassHealth: The Basics? If so, join us on Wednesday, February 5th, from 12:00 - 1:00 PM for a webinar to review key facts and data about MassHealth eligibility, benefits and delivery systems, costs, and recent reforms from our October 2024 edition of the MassHealth: The Basics – Facts and Trends chart pack. The goal of the webinar is to provide participants with basic background information about MassHealth, including what benefits MassHealth covers, who it serves, program spending, and a status update on the state’s latest delivery reform efforts. Click here to register for the webinar. NOTE: This webinar will cover the same content as our November 2024 webinar on MassHealth: The Basics.

In 2023, the Foundation released a statewide Health Equity Action Plan, which proposed a vision and framework for achieving a racially and ethnically equitable health care delivery system in Massachusetts. To advance the Action Plan and as a step towards more coordination and cross-system learning among Massachusetts stakeholders, the Foundation, in collaboration with Manatt Health, developed the Massachusetts Health Equity Initiative Inventory and accompanying brief explainer. The Inventory is an interactive resource in Microsoft Excel that contains over 140 interventions and programs being implemented to address racial, ethnic, and linguistic inequities in Massachusetts’ health care delivery system. Each initiative featured in the Inventory includes a brief description and information on outcomes, where available. Users can sort initiatives by various categories, including:

• clinical area of focus, 
• population, 
• geographic region, 
• funding source, and 
• type of implementing entity.

The Inventory was developed as a tool for organizations across the health care delivery system in Massachusetts looking to start or advance their health equity work, offering examples and promising practices of initiatives across various areas of focus. It can also be used by other stakeholders, including state agencies, policymakers, and funders to inform programmatic and funding priorities. 

As organizations adopt and update their health equity initiatives, the Foundation will periodically update the Inventory and will keep the most up-to-date version on its website. If you would like to submit an initiative or update information related to an existing initiative, you can do so via this form.

On Tuesday, December 3rd, 2024, the Foundation hosted a webinar on the Inventory. During the webinar the speakers discussed the impetus for the Inventory, shared key takeaways and lessons learned from compiling this resource, and highlighted how it may be used by organizations in various phases of their health equity journey. The webinar also featured a demonstration of how to use this interactive tool. Click here to access a recording of the webinar and a copy of the webinar slides.

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.

The chart pack provides comprehensive yet accessible data and explanations of program updates to help policymakers, administrators, advocates, and academics better understand the complex MassHealth program. It is made available in PDF and PowerPoint formats to facilitate its use in presentations.

On November 20, 2024, MMPI hosted a webinar to review facts and data about MassHealth eligibility, benefits and delivery systems, costs, and recent reforms from the latest edition of MassHealth: The Basics. Click here to access a recording of this webinar and a copy of the webinar slides.

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

A la luz de los crecientes esfuerzos de MassHealth y otras agencias de Medicaid para colaborar con las personas que han vivido la experiencia de Medicaid y con el fin de mejorar los resultados de salud y avanzar en la equidad, la Fundación encargó dos reportes informativos. El primer reporte, Estrategias para Involucrar Significativamente a los Miembros de MassHealth para Informar las Decisiones de Programas y Políticas, se publicó en junio de 2024 e hizo una serie de recomendaciones para reforzar la estrategia general de participación de los afiliados de MassHealth.

Este segundo informe examina en profundidad una herramienta específica de participación de los afiliados: Los Consejo de Asesores Comunitarios (CABs). Los CABs son grupos de personas, incluidos miembros actuales y antiguos de Medicaid, que participan en un diálogo estructurado, coherente y a largo plazo para informar sobre el diseño de políticas y programas de Medicaid. MassHealth, las organizaciones de atención administrada y las organizaciones de atención responsable ya emplean CABs para informar programas específicos de MassHealth, y MassHealth ha anunciado su intención de crear CABs para todo el programa.

Este informe busca identificar prácticas prometedoras para el diseño y la implementación de CABs en el contexto de MassHealth. Basándose en un análisis de entorno, entrevistas con partes interesadas y conversaciones con los propios miembros de MassHealth, este informe delinea principios rectores o “north stars” [estrellas del norte] para establecer CABs. También detalla recomendaciones prácticas para diseñar y operar CABs eficaces.

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

In light of increased efforts by MassHealth and other Medicaid agencies to engage with individuals who have lived experience with Medicaid and in order to improve health outcomes and advance equity, the Foundation commissioned two informative reports. The first report, Strategies for Meaningfully Engaging MassHealth Members to Inform Program and Policy Decisions, was released in June 2024 and made a series of recommendations to strengthen MassHealth’s overall member engagement strategy. 

This second report takes a deeper look at one specific member engagement tool: Community Advisory Boards (CABs.) CABs are groups of people including current and former Medicaid members that engage in structured, consistent, and long-term dialogue to inform Medicaid program and policy design. MassHealth, managed care organizations, and Accountable Care Organizations already employ CABs to inform specific MassHealth programs, and MassHealth has announced its intention to create a program-wide CAB.

This report aims to identify promising practices for design and implementation of CABs in the context of MassHealth. Based on an environmental scan, stakeholder interviews, and conversations with MassHealth members themselves, this report outlines guiding principles or “north stars” for establishing a CAB. It also details practical recommendations for designing and operating effective CABs. 

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.

The federal authority under which One Care has operated is ending as of December 31, 2025. The Commonwealth will need to transition the program to a new authority. While the One Care program itself will remain, operating it under a new authority with different rules and structures means there will be some program changes. However, Massachusetts has designed a plan to preserve the care model and benefits of One Care, and adopted alternative approaches to providing as integrated an experience for members as possible.

The purpose of this report is to provide background on the One Care program as it exists today and to educate policymakers, advocates, and other stakeholders of One Care’s upcoming transition to a new federal authority. 

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.

Based on input from select Massachusetts stakeholders and early implementation data, this report describes the key components of the Roadmap and how they are intended to improve access to behavioral health care services. It also provides an update on implementation of the Roadmap, describes early successes and challenges, and identifies opportunities to strengthen implementation moving forward. 

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:

1. Outlines a framework for understanding different strategies along a continuum of community involvement for engaging with individuals with lived experience.
2. Summarizes MassHealth’s current approach to engaging with members.
3. Describes a set of guiding principles for building a meaningful statewide Medicaid member engagement strategy.
4. Introduces a series of recommendations for building and strengthening MassHealth’s current member engagement strategy.

This is the first of two reports in a series on member engagement. The second report, which takes a deeper look at one specific member engagement tool – Community Advisory Boards (CABs) – will be released this summer.

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. This primer provides a thorough landscape assessment of LTSS in Massachusetts and serves as a follow-up to the Foundation’s December 2022 report, A Focus on Health Care: Five Key Priorities for the Next Administration, which identified improving access to LTSS as one of five key areas requiring immediate and focused action in Massachusetts.  

This primer is intended to help stakeholders better understand LTSS in Massachusetts: what these services are, who uses them, and how they are delivered and paid for. In summarizing the available data on LTSS payers and programs, utilization and spending, workforce capacity, and quality, the primer highlights the strengths and the challenges in LTSS delivery and access in Massachusetts today.  It also identifies opportunities and considerations for improving access to and quality of LTSS in Massachusetts.

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.

This report proposes a statewide Health Equity Action Plan that offers an organizing structure, process, and set of practical steps for collectively achieving a racially and ethnically equitable health care delivery system in Massachusetts. The Health Equity Action Plan is accompanied by a toolkit, which includes an illustrative set of interventions and best practices that providers, health care delivery system leaders, and other stakeholders can deploy to achieve the envisioned system.

The focus of this report is on racial and ethnic inequities in the health care delivery system and therefore can be considered a first phase in a larger system-wide effort to eliminate all inequities that affect people’s health.

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:

• The history, structure, key features, and payment model of the ACO program.
• Information on who is eligible for MassHealth ACOs, the enrollment process, and ACO enrollment as of June 2023.
• Details on enhanced services that are provided to certain ACO members.
• A review of what is known about how ACOs have performed to date.

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.

The chart pack provides comprehensive yet accessible data and explanations of program updates to help policymakers, administrators, advocates, and academics better understand the complex MassHealth program. It is made available in PDF and PowerPoint formats to facilitate its use in presentations.

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. People who are Black or Hispanic, or who have lower incomes, experience significantly higher rates of uninsurance than the state population overall. As a result, these groups are more likely to face access barriers and financial insecurity associated with being uninsured.

The purpose of this report is to begin charting a course toward closing the coverage gaps in Massachusetts, with a particular focus on creating a more racially and ethnically equitable system of coverage. The report and accompanying infographics describe the people in Massachusetts without health insurance and the barriers to coverage they face, including affordability, administrative complexity, and immigration, language, and cultural barriers. It then proposes a menu of policy options that address the specific circumstances in Massachusetts. The proposed options are meant to inform a statewide conversation about the best approaches to closing the remaining coverage gaps in Massachusetts and removing structural barriers that result in racial and ethnic disparities in health insurance coverage.

Behind the Data: Voices of the Uninsured
The Foundation recently released a 3-minute video featuring four Massachusetts residents who describe their experiences without health insurance. The video is also available with English subtitles and Spanish subtitles (con subtitulos en Español).

Click here to view

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 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.

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. This resource is intended to be used by advocates, enrollment assisters, and other stakeholders to assist consumers in identifying options to protect their access to coverage and health care services. Since policies and programs are changing frequently in the current environment, this resource will be regularly updated.

Stay up to date on changes to this resource by signing up for our email list.

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.