Insurance coverage

New five-year MassHealth deal will improve homeless insurance coverage and hospital funding

“We know that many people who are eligible for Medicaid lose their coverage on a full month’s renewal, not because they aren’t eligible, but because they didn’t get paperwork in the mail,” said Daniel Tsai, deputy administrator of the Centers for Medicare and Medicare Services. Tsai, who previously oversaw Massachusetts’ Medicaid program, spoke about the approval at a press conference Wednesday.

The waiver will also provide additional federal funding to hospitals by agreeing to match dollars raised by increased assessment of state hospitals. Ultimately, the hospital funding program will generate more than $600 million in profits for hospitals annually over the next five years, state officials said.

Dr. Eric Dickson, CEO of UMass Memorial Health and an early proponent of the plan, said assessed hospital dollars and federal matching will be used to increase Medicaid rates and fund quality improvement and incentives. to health equity.

Not all Massachusetts hospitals will see a net gain under the revised program. UMass itself will pay a $60 million assessment and recoup $50 million through improved Medicaid rates, but it will have the opportunity to earn more through quality metrics.

However, funding will be essential for institutions that serve a large population of Medicaid patients, called “safety net hospitals.”

“Everyone in the state has recognized the pressure that safety nets are under right now,” Dickson said. “If they fail, you are going to have big problems in the other hospitals. Patients have to go somewhere.

Dickson credited Steve Walsh, CEO of the Massachusetts Health & Hospital Association, with bringing together the many pieces needed to make the deal happen. In a statement, Walsh called the approval “a major victory for patients and hospitals in Massachusetts.”

The waiver, in addition, will invest $115 million annually in primary care and will invest more than $43 million over five years in loan repayment and residency training programs for primary care and behavioral health staff. serving MassHealth members.

Governor Charlie Baker noted that the waiver would also support the state’s behavioral health reform initiative, expanding treatment services for substance use disorders and other behavioral health services.

“I can’t put too big of an exclamation mark on this capacity issue,” Baker said at the press conference. “One of the biggest challenges we have in behavioral health is that we haven’t adequately funded it for a very long time, which is one of the reasons we don’t have enough clinicians in the field and why so many people struggle to get an appointment.”

The agreement will also make changes to the “accountable care organization” model that MassHealth introduced in 2018. Under an ACO, a group of doctors, hospitals, and other providers agree to be accountable not only the quality of a member’s care, but also the cost. The waiver will subsequently launch a five-year, more than $2 billion initiative to hold CCOs and participating hospitals accountable for reducing health care disparities.

The waiver will also allow certain programs to be continued and expanded under a new framework to meet health-related social needs, such as nutrition and housing.

“It’s not easy to negotiate. They cover a large territory and a huge amount of money,” Baker said. “I can’t express how important it is that this be done in a timely and reasonable manner to us here in Massachusetts.”


Jessica Bartlett can be contacted at jessica.bartlett@globe.com. Follow her on Twitter @ByJessBartlett.