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Massachusetts health care — wonky, with a healthy dose of reality

Feds Approve MassHealth Waiver Proposal

Feds Approve MassHealth Waiver Proposal

November 4, 2016

Today the federal Centers for Medicare and Medicaid Services (CMS) approved Massachusetts' application for a broad restructuring of the MassHealth Medicaid program.

The "1115 waiver" allows the state to implement Accountable Care Organizations as a new choice for MassHealth members. An ACO is made up of primary care providers who team up to provide integrated, coordinated care, with the goal of both treating patients when they are sick, and keeping members healthy. They will work with community organizations to assist members with social needs that keep us healthy, like nutrition or housing. The waiver also provides the state with lots of new federal funds. It includes $1.8 billion over five years of new funding to support the move to ACOs, invest in behavioral health and long term services and supports, and promote innovative ways of addressing the social determinants of health.  It also authorizes nearly $6 billion of additional safety net care payments over five years to hospitals and the health safety net for low income uninsured and underinsured residents, and for subsidies to assist consumers in obtaining coverage through the Health Connector.

The waiver also increases opportunities for consumer involvement. ACOs are required to include a consumer representative on their boards, and each ACO must have a Patient and Family Advisory Committee.

More information on the waiver is here:

HCFA released the following statement following the news:

“Health Care For All (HCFA) welcomes this Medicaid waiver as an opportunity to transform MassHealth from just a program that takes care of people when they are sick to one that aims at keeping people healthy in the first place. We are particularly excited about the potential to integrate physical, behavioral health and long-term care with other social services. We hope that this overhaul expands in the future to include oral health and dental care as well, which we know are critical to overall health. HCFA will be watching closely as the state implements the innovative reforms approved today to make sure that consumer needs are the top priority.”

Six pilot ACOs will start operating this December, and the full ACO system should be up and running a year later. We congratulate the state on their approval, and pledge to closely monitor implementation of the waiver on behalf of Massachusetts consumers.

                                                                                                                                                                                     -- Brian Rosman