With $52.4 Billion Waiver, Baker Administration Will Retool MassHealth

BOSTON, MA – The federal government on Friday approved a massive funding infusion, giving the governor's administration the green light to retool its MassHealth program, pursuing a bid to better care for its Massachusetts' Medicaid population and to manage the program's ballooning costs.

The waiver, approved Friday by the Obama administration, allows states to pursue experimental, pilot, or demonstration projects, according to the Centers for Medicare & Medicaid Services. Its purpose is to give states additional flexibility to design and improve their programs, the Center says.

In Massachusetts, this opens the door for what Gov. Charlie Baker in a press release called "the first major overhaul of the MassHealth program in 20 years."

According to the governor's office, the waiver provides the funding flexibility to move Massachusetts from a fee-based model to a system of Accountable Care Organization models designed to work in close partnership with community-based organizations to integrate care for behavioral health, long-term services and supports and health-related social needs.

The federal waiver provides funding to support the move to ACOs, and authorizes MassHealth to launch an ACO pilot program beginning this December.

According to the governor's office, "The ACO pilot program will transition MassHealth from the current fragmented, fee-for-service care model towards accountable care and population-based payments with selected ACOs under an alternative payment methodology that includes shared savings and risk.

MassHealth is a state program that combines the Medicaid and the Children’s Health Insurance Program, providing doctors visits, prescription drugs, hospital stays, and many other important services at little or no cost for many members. It also oversees the state's Health Connector, Massachusetts' Marketplace for health and dental insurance under the Affordable Care Act.

Currently, 1.9 million Massachusetts residents utilize MassHealth, according to the governor's office. That's about one in four people in the state, according to the Boston Globe, which reports that the ACO model has been supported by the federal government, but could cause disruption and confusion for MassHealth members in the short-term.

State Secretary of Health and Human Services Marylou Sudders said in a statement that the Medicaid waiver approved Friday "authorizes more than $52.4 billion to the MassHealth program over the next five years, expands substance use benefits to address the opioid epidemic, and secures important investments for strengthening the community-based health care system for behavioral health services and long term supports.”

Without the waiver, Massachusetts would have lost $1 billion a year in federal funds starting next summer, according to the governor's office.

Patch will update this story.

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