MassHealth/ Medicaid

In Massachusetts, Medicaid and the Children’s Health Insurance Program (CHIP) are combined into one program called MassHealth. Medicaid is a shared state and federal program to provide health insurance for poor and disabled residents. CHIP is medical coverage source for individuals under age 19 whose parents earn too much income to qualify for Medicaid, but not enough to pay for private coverage. MHA monitors prospective and recently implemented changes to MassHealth, provides information about how specific aspects of the plan affect care providers, and advocates for fair and equitable implementation of the program. 
A new Expedited Psychiatric Inpatient Admissions Policy, or EPIA 2.0, builds on the original EPIA that was released in February 2018.
A new MassHealth policy that would require prior authorizations for more than 350 medical and diagnostic services is on hold for now.
Governor Charlie Baker last Friday introduced the latest legislative proposal to reform the state’s healthcare system.
Massachusetts is seeking input on the design of a new initiative called “Moving Massachusetts Upstream” (MassUP).
The state has released the 2020 RFA – the main contract between the MassHealth program and acute care hospitals serving Medicaid patients.
MassHealth has extended the acute hospital 2019 RFA one additional month through October 31, 2019.
The Executive Office of Health and Human Services (EOHHS) has issued proposed changes to the two regulations governing Health Safety Net (HSN) eligibility and payments.
Last Wednesday, Governor Charlie Baker signed a $43.3 billion FY2020 state budget, and did not issue a single spending veto.
MassHealth has released several bulletins regarding the coverage and coding of Medication for Addiction Treatment (MAT) in order to increase access to treatment.
The State Senate begins debate tomorrow on the Senate Ways & Means proposed state budget for FY2020 and the 1,100-plus amendments to it that have been filed.
The Massachusetts House of Representatives today begins debate on the proposed FY2020 state budget, and the nearly 1,400 amendments to it that have been filed.
MHA will be working with legislative champions in the House to strengthen the FY2020 budget directive in a manner that will ensure the administration fulfills the $15 million transfer to the Health Safety Net.
The Health Policy Commission in coming months is scheduled to decide on whether the state’s healthcare cost growth benchmark – currently set at 3.1% – should remain at that level.
The 2018 Cost Trends Report from the Health Policy Commission released last month showed the persistent growth in prescription drug spending over the state’s healthcare cost growth benchmark.
The state’s bold experiment with its dual eligible programs is getting some revisions, while raising some concerns among hospitals and physicians.
In a letter to CMS last week, MHA urged the federal agency to reconsider rules regarding how Medicaid Managed Care Organizations (MCOs) direct payments to providers.
As 2019 begins, here are a few key developments that should occur.
The 1.6% total healthcare spending growth rate in Massachusetts was well below the national rate.
Care is fluid and ever-changing and should not be determined by a rigid number arrived at through popular vote. Vote NO on 1.
The 2019 acute care hospital Request for Application was released last week and will take effect November 1.

Resources

Click on the links below for easy access to important information related to state healthcare issues and advocacy.
Visit the Commonwealth of Massachusetts websites below to find information on legislative hearings and other meetings of interest to the healthcare community.
To guide your navigation of the legislative process and assist your advocacy efforts, please visit the following state websites:
MHA has also developed the following documents for your information and benefit:
  • Directory of Government Officials
  • 2016-2017/2017-2018 State Legislative Package