MA- Feds approve five-year, $67 billion Medicaid waiver


MM Curator summary

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[MM Curator Summary]: MA just got a gigantic influx of cash for its new waiver, and is working on a provider tax magic money feature to get even more.


Highlights: behavioral health, social needs integration, and hospital assessment


BOSTON, MA – January 25: Mass. Gov. Charlie Baker speaks at his State of the State address at the Hynes Auditorium on January 25, 2022 in BOSTON, Massachusetts. (Staff Photo By Stuart Cahill/Boston Herald)

Massachusetts will be able to invest tens of millions of dollars into primary and mental health care workforce development and offer continuous Medicaid eligibility for some vulnerable populations under a five-year, $67 billion Medicaid waiver federal officials approved Wednesday.

Gov. Charlie Baker joined officials from the Centers for Medicare and Medicaid Services to announce the new waiver deal, which lands just two days before the $52.5 billion waiver the Obama administration approved in 2016 was set to expire, and to tout what he described as “critically important elements” it includes.

Baker said Massachusetts “will be able to do many things under this waiver to expand both service delivery and capacity,” highlighting mental health care as an area particularly bolstered by the agreement that represents federal support to move beyond the basic contours of Medicaid requirements.

“I can’t put too big an exclamation point on this capacity question,” Baker said during a press call. “One of the biggest challenges we have with behavioral health is we haven’t funded it adequately for a very long time, which is one of the reasons why we don’t have enough clinicians in the field and why so many people have trouble accessing an appointment. This is going to give us the ability to invest $120 million over five years in loan repayment and residency training programs to strengthen and diversify the primary care and behavioral health workforce serving our MassHealth members.”

A Baker spokesperson said after the press call that the waiver actually allows investment of $43 million, not $120 million, in the loan repayment and training programs.

Congressman Richard Neal described the goals underpinning the waiver as “enhancing value-based care, advancing health equity, supporting safety net providers, and continuing the Commonwealth’s impressive near-universal health coverage.”

Many other states have Medicaid waivers, sometimes referred to as Section 1115 demonstration waivers, that allow them to tailor the public health insurance programs to more closely align with their specific preferences and needs.

The latest Massachusetts waiver, announced alongside a newly approved waiver for Oregon, will take effect Oct. 1 with the start of the new federal fiscal year and stretch well beyond Baker’s time in office.

Among the provisions officials highlighted are new measures to keep Medicaid accessible to Bay Staters at risk of falling through gaps in the system. MassHealth beneficiaries will be able to receive up to a year of continuous coverage when they are released from correctional settings like prisons and jails.

Those facing chronic homelessness can receive two years of continuous eligibility, which Baker said “is going to be really important to not just their home status, but also their capacity to focus on other things like trying to make themselves better and find their way to a better circumstance generally.”

CMS Deputy Administrator Dan Tsai, who spent more than six years running the Medicaid program in Massachusetts before he joined the Biden administration in June, said Wednesday that many people eligible for Medicaid lose their coverage after 12 months “not because they’re not eligible, but because they did not get a piece of paper in the mail or make it through the redetermination process.”

“We’re excited that both (Oregon and Massachusetts) are taking innovative, forward-leaning approaches to really thinking about making sure that eligible individuals maintain coverage for Medicaid,” Tsai said.

MassHealth, which combines Medicaid and the Children’s Health Insurance Program (CHIP) under one umbrella, is a massive program providing coverage to roughly 2 million people. It represents the largest cost driver in the annual state budget, accounting for nearly $19.5 billion — funded by both the state and federal government — of the $52.7 billion fiscal year 2023 budget Baker signed in July.

In addition to the primary and mental health care investment, Baker said the waiver will provide a “new framework” to integrate health-related social needs into programming and to incorporate nutritional and housing support services into the state’s accountable care organization (ACO) program.

CMS Administrator Chiquita Brooks-LaSure linked the waivers approved Wednesday to the White House Conference on Hunger, Nutrition and Health kicking off the same day, which Biden administration officials described as the first conference of its kind in more than half a century.

“These approved demonstrations are truly innovative and will ensure that Medicaid eligible people and families in these states can access meaningful, whole-person health care they need to thrive,” Brooks-LaSure said.

Another feature in the waiver, according to Baker, is approval of an assessment on larger acute care hospitals, which Baker’s deputies previously said would make more than $600 million available each year for hospitals to promote health equity.

“Yes, it does include the hospital assessment, and the goal and the expectation is that we will implement it as quickly as it possibly can,” Baker said. “It’s basically been statutorily authorized by the Legislature, and we were waiting for the waiver process to end before we’d be able to implement it. That does make it possible for us to increase our financial support for many of the hospitals that deal with a significant portion of the MassHealth population.”

The Massachusetts waiver also “supports a behavioral health roadmap” the Baker administration started to implement before the COVID-19 pandemic, Baker said.

“Obviously coming out of the pandemic, behavioral health issues are a screaming issue for everybody, I think, in the health care space and just generally,” he said.


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