Medicaid

A Primer on the Dual Eligible Population in Massachusetts

Of the more than 1.8 million people enrolled in MassHealth, Massachusetts’ Medicaid program, one in five are dually eligible and receive health care coverage through two distinct payers – Medicare and MassHealth. This educational primer was developed to build a deeper understanding of the dual eligible population in Massachusetts. It illustrates the diversity of dual eligible individuals’ clinical and functional needs, service utilization, and spending patterns.

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UPDATED! Promoting Access to Care and Coverage During a Public Health Crisis: COVID-19–Related Changes Affecting MassHealth, Health Connector, and Health Safety Net

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.

UPDATED! MassHealth and ConnectorCare Enrollment Tracker

This resource highlights the most recent monthly enrollment data available for MassHealth and ConnectorCare — the two most prominent sources of publicly financed health insurance in Massachusetts. The compiled data and highlighted trends described in this resource are intended to help policymakers, health care stakeholders, and others track how enrollment in these programs has changed since the COVID-19 pandemic began affecting public health and the economy of the Commonwealth. This resource will be updated regularly with the latest enrollment data as it becomes available.

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Understanding Legal Challenges to the Affordable Care Act: A Brief Review of Key Issues

This educational brief describes the key elements of the Affordable Care Act (ACA) and provides an overview of California v. Texas, a case currently before the U.S. Supreme Court that seeks to overturn the ACA. Also included in this brief is a discussion of recent relevant case history and how the arguments in California v. Texas build upon prior legal challenges to the ACA.

Potential Coverage and Federal Funding Losses for Massachusetts if California v. Texas Ultimately Overturns the Affordable Care Act

California v. Texas, a case currently before the U.S. Supreme Court, seeks to overturn the Affordable Care Act (ACA). The court is expected to begin hearing arguments on this case on November 10, 2020. A final ruling that overturns the ACA would have widespread implications, affecting every state in the nation.

MassHealth: The Basics – Facts and Trends (October 2020)

This UPDATED (October 2020) edition of the MassHealth: The Basics chart pack provides new data on MassHealth enrollment and spending from the most recent state fiscal years available, as well as a high-level overview and status update on the state’s delivery system reform efforts. The 2020 chart pack features a summary of the many temporary policy and programmatic changes that MassHealth quickly implemented in response to the COVID-19 pandemic.

The Final Public Charge Admissibility Rule: Implications for Massachusetts

The revised federal public charge rule – which was finalized in August 2019 and took effect in Massachusetts in February 2020 – makes it harder for certain low- and moderate-income immigrants to obtain green cards or visas if they have applied for or enrolled in public benefits such as MassHealth or the Supplemental Nutritional Assistance Program (SNAP). This report describes the expected effects of the revised federal public charge rule on MassHealth and SNAP enrollment, and its downstream effects on the health of Massachusetts residents, health care providers, and the state’s economy.

What to Know About ACOs: The Latest on MassHealth Accountable Care Organizations

This brief builds upon a July 2018 publication, What to Know About ACOs: An Introduction to Accountable Care Organizations, which was developed as a resource for stakeholders (i.e., providers, health care administrators, and policymakers) to help explain the key elements of MassHealth ACOs, including the three types of ACOs, who they serve, and the services they provide.

MassHealth: The Basics – Facts and Trends (July 2019)

This UPDATED (July 2019) edition of the MassHealth: The Basics chart pack provides new data on MassHealth enrollment and spending from the most recent state fiscal years available, as well as a high-level overview and status update on the state’s delivery system reform efforts. The 2019 chart pack features a summary of the program’s impacts on access to care and health outcomes and new data highlighting the role of MassHealth in supporting the low-income workforce.

What is the Actual State Cost of MassHealth in 2019?

Among state budget items, MassHealth is well known as one of the largest spending categories, while its role as a significant source of federal revenue is often overlooked. This brief takes a look beyond the budget totals to help stakeholders better understand the actual state cost of MassHealth when factoring in the state and federal partnership that finances this program. In fiscal year (FY) 2019, the state projects it will spend approximately $16.7 billion on MassHealth. This total (or “gross” amount) is approximately 36 percent of total estimated state spending for FY 2019.

Faces of MassHealth: Portrait of a Diverse Population

This collection of materials goes beyond the topline statistics often used to characterize those served by MassHealth in order to paint a richer, more meaningful picture of the more than one in four Massachusetts residents enrolled in the program. MassHealth serves our most vulnerable residents across their life spans from infants and children with special needs who gain access to comprehensive health care and support services required to reach their full potential, to the elderly and those living with disabilities who receive community based care that helps them remain in their homes.

2018 Massachusetts Health Reform Survey

This collection of materials is the latest in a series by the Urban Institute summarizing the findings from the 2018 Massachusetts Health Reform Survey (MHRS). The Foundation began conducting the MHRS in fall 2006 to support the evaluation of Massachusetts’ 2006 health care reform bill. The survey has been fielded periodically since 2006 – most recently in spring 2018 – to monitor key measures pertaining to health insurance coverage and health care access and affordability among non-elderly adults (ages 19-64) in Massachusetts.

The Proposed Public Charge Rule: An Overview and Implications in Massachusetts

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.

How are Massachusetts Community-Based Organizations Responding to the Health Care Sector’s Entry into Social Determinants of Health?

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.

Addressing Major Drivers of MassHealth Per-Enrollee Spending Growth: An Analytic Review and Policy Options

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.

What to Know About ACOs: An Introduction to MassHealth Accountable Care Organizations

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.

REVISED - A Guidebook to Social Services for MassHealth ACOs

This guidebook is designed to help health care administrators and providers better understand the types of social services available in Massachusetts, the organizations that provide such services, and their key sources of funding. This resource is intended to facilitate greater coordination between these organization types, and especially with MassHealth ACOs as they seek to integrate, better coordinate with social services, improve health outcomes, and reduce health care costs.

A History of Promoting Health Coverage in Massachusetts

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:

Partnerships for Health: Lessons for Bridging Community-Based Organizations and Health Care Organizations

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.