INSIDE THE ISSUE

> Shield Law
> DRIVE Initiative
> Health-Related Social Needs
> Redeterminations

MONDAY REPORT

State Moves Quickly to Update Shield Law

Last Thursday, the Massachusetts House and Senate reached agreement on legislation aimed at protecting reproductive and transgender care from legal challenges. The bill strengthens the state’s 2022 “Shield Law” to safeguard both providers and patients seeking those services. It passed 132-24 in the House and 37-3 in the Senate and was sent to Governor Healey for her signature.

Of note, the bill focuses heavily on the disclosure of sensitive data such as permitting prescription labels to show a practice name instead of an individual physician’s name, while formally establishing a state requirement that abortion care be provided in emergencies when medically necessary. It prohibits state and local actors from providing information or assistance to another entity, state, or federal government if that info is related to legally protected healthcare services.

“Once again, our local leaders have met the moment to protect Massachusetts patients and healthcare providers who want nothing more than to keep safe, clinically necessary care private and accessible,” said Emily Dulong, MHA’s vice president, government advocacy & public policy. “Our hospitals and health systems were given a chance to weigh in with thoughtful feedback as this bill was refined to ensure that patient quality and safety were equally prioritized, and are thankful to the Attorney General and legislature for safeguarding the health and wellbeing of countless people for years to come.”

Due to the technical complexity of the legislation’s requirements and to ensure access to appropriate clinical information, MHA and its partners successfully advocated and secured language to establish an advisory group tasked with examining ways to standardize service definitions, terminology, and structured data; reduce the burden of patient consent forms (such as through consent management platforms); improve appropriate data sharing and interoperability; consider exemptions for data used in treatment, payment, and healthcare operations; and minimize penalties for providers making good faith efforts to comply. The advisory group will sunset in 2027. The final bill also includes two amendments that make technical corrections to inexact definitions to ensure that health information is appropriately shared solely for the purposes of payment, treatment, or healthcare operations, in line with HIPPA requirements.

Governor Says DRIVE Initiative Does More Than Fill Funding Gap

The Trump administration’s cuts to hospitals, health systems, and educational institutions engaged in scientific research was one – but not the only – reason for a proposed $400 million “Discovery, Research and Innovation for a Vibrant Economy (DRIVE) Initiative” that Governor Maura Healey unveiled last Thursday.

“People around the world are saved by science and saved by Massachusetts science,” Healey said, standing before business, healthcare, educational, and labor leaders, among others. “We’re taking action to secure scientific progress and advance the medical cures that patients rely on.”

The legislation would also create a Research Catalyst Fund that can accept and distribute philanthropic gifts and industry matching funds. A new Research Opportunity Review Board will oversee the fund.

“This isn’t just about filling gaps left by federal cuts,” Healey said. “This is forward looking, it’s innovative, it’s an economic driver and a job creator, and it is going to power the world. We’re seizing another opportunity for Massachusetts to lead.”

In making the announcement, Governor Healey stressed the state’s commitment to strengthening the Health Safety Net, especially in light of the federal government’s nearly $1 trillion cut to the Medicaid program. Among others speaking at the event was Kevin Churchwell, M.D., the president and CEO of Boston Children’s Hospital and a member of the MHA Board of Trustees. Children’s runs the largest research program for children in the world, employing more than 3,000 scientists. “Our research, in collaboration with other institutions, has made an incredible difference and is creating an environment where the effect on our kids, on our patients and families is incredibly profound,” Churchwell said. “We are providing them a future, a future of hope.” He said the federal cuts and especially “the unpredictability” is sending the worst possible message to researchers about the value and importance of their work. Churchwell said Healey’s proposal “recognizes the things that makes Massachusetts special and plays to our collective strengths.”

CHIA Study Outlines Persistent Disparities

The state’s Center for Health Information and Analysis (CHIA) last week published a study showing how black and Hispanic residents experience significantly higher rates of unmet health-related social needs – such as food insecurity or housing instability – than white residents in the state.

People who consistently have worries about running out of food or being unable to meet their rent or mortgage payments, may then be unable to access, use, or pay for healthcare services, which leads to disparities in care and worse outcomes.

While a significant proportion of Massachusetts residents (39.1%) had an unmet health-related social need (HRSN) in the past 12 months, black and Hispanic residents were more than two times as likely to experience any unmet HRSN compared with white residents. Black and Hispanic residents were three times as likely to experience food insecurity as white residents, and reported financial strain at twice the rate of white residents. Compared with white residents, black and Hispanic individuals were nearly three times as likely to experience housing instability, CHIA reported in the brief entitled Black and Hispanic Residents in Massachusetts Report Higher Rates of Unmet Health-Related Social Needs in Their Families.

“This analysis finds that race and ethnicity remain strongly associated with unmet HRSNs even after adjusting for family income, educational attainment, family composition, and activity limitations/health status of family members,” CHIA wrote.

Under the state’s ambitious five-year Medicaid waiver, Massachusetts hospitals are participating in a groundbreaking Hospital Quality and Equity Initiative Program — a first for Medicaid waivers. The waiver commits hospitals to, among other things, enhancing patient data collection to better identify disparities across race, ethnicity, language, and disability (RELD), and sexual orientation and gender identity (SOGI); screening patients for their health-related social needs, which includes gathering information about their housing, food security, and more; and improving access for patients with disabilities and for whom English is not their primary language. Over time, hospitals will be held accountable for reducing clinical disparities and improving the patient experience.

Future Redeterminations Will Be a Significant Undertaking

When the enrollment and coverage flexibilities that had been in effect throughout the COVID-19 pandemic began to be phased out, federal rules imposed in 2023 required states to carry out sweeping Medicaid redetermination processes – that is, re-enrolling millions of people into the program.

In Massachusetts, the Executive Office of Health and Human Services initiated a comprehensive outreach campaign to educate MassHealth beneficiaries on the eligibility redetermination process and worked closely with patient groups, healthcare providers, and health plans to support the significant work involved with verifying eligibility for more than two million MassHealth members. Health Care For All (HCFA) helped lead a focused effort to mobilize direct outreach in communities with the highest number of MassHealth members and worked with 50 community partners to do so. Under the HCFA effort, volunteers knocked on more than 500,000 doors in 15 targeted communities and ran ads in 65 local news outlets in nine languages to assist people keep their coverage. More than 1.2 million people were reached through 2,700 events in those communities.

Now the complicated, labor and cost intensive redetermination process is once again rearing its head through the recently passed One Big Beautiful Bill (OB3) that will require two redeterminations per year for the Affordable Care Act expansion population, which totals about 350,000 people in Massachusetts. The wildly held concern, based on the past redetermination effort, is that many people will lose coverage, because of mistakes filling out forms, lack of information on the need to reapply, missed deadlines, or other such administrative blunders.

Amy Rosenthal, the executive director of Health Care For All, who helped choreograph the massive MassHealth redetermination, was featured last week in MHA’s Executive Insights webinar series and spoke of the upcoming challenge under OB3.

“What’s coming out of D.C. right now is really challenging,” Rosenthal said. “I think it’s something that we have not seen before, and this is going to be a new set of challenges. If I had to be anywhere right now I’d want to be here in Massachusetts because I know we have a commitment to coverage. We have a culture of coverage here that I think is really important.

“There are going to be some people who are going to lose health insurance [under OB3], and there is going to be very little that we’re going to be able to do to help those people other than working on our advocacy side and really thinking about what comes next for them. There’s a whole other set of people who are going to potentially lose healthcare coverage because of changes in red tape and bureaucrat issues around enrollment, and for Health Care For All that’s kind of our sweet spot, and that’s where we are hoping to work with as many people as possible, including all the hospitals as well as other stakeholders, on running another large scale campaign to help people keep their coverage.” Rosenthal said a coordinated, across-the-healthcare-continuum approach is the only way such an outreach program can work.

“If a community resident gets a knock on their door from one of their neighbors who says, ‘Hey, in order to keep your coverage, you’re going to have to do these things,’ and then that person goes to their local health center or goes to see their dermatologist, and they hear, ‘In order to keep your coverage, you’re going to need to do this,’ and then their insurance company is sending them the same information – well, the more people hear it in a consistent way, the more likely we are to keep people covered,” Rosenthal said. “And so I really look at this as an important opportunity, and Massachusetts is incredibly well prepared to do this and Health Care For All is really hoping to jump in and play a role for people.”

John LoDico, Editor