INSIDE THE ISSUE

> Safety Net Relief!
> Safety & Violence Guidance
> DSH Cuts Looming
> Medicare Open Enrollment
> Implementing the Nurse Licensure Compact
> Transitions

MONDAY REPORT

House Supplemental Budget Contains Key Health Safety Net Relief

A supplemental budget bill designed to close out state spending in Fiscal Year 2025 passed the Massachusetts House last Wednesday, and moves to the Senate for consideration this week.

The $2.25 billion proposal contains a critical amendment, offered by Rep. John Lawn (D-Watertown), that raises the annual assessment on hospitals by $50 million, which in turn would increase the federal Medicaid matching funds the state receives. Under the proposal, the state would also contribute $50 million in both FY2026 and 2027 from the Commonwealth Care Trust Fund to the Health Safety Net fund that pays hospitals and health centers for the care provided to uninsured and underinsured individuals. Federal revenues will also be dedicated to the Health Safety Net. Without the funding relief, that safety net fund is expected to run annual deficits that MHA estimates would be $310 million and $340 million in FY2026 and FY2027, respectively. Hospitals alone bear the funding shortfalls.

The complex amendment lays out detailed assessment and payment allocations for hospitals. Ultimately, the plan generates $100 million for the Health Safety Net program, and $112 million in supplemental payments to hospitals.

In his speech on the House floor, Rep. Lawn said, “We are confronting a challenging road ahead. Looming federal Medicaid cuts threaten the healthcare system. A strong Health Safety Net will be needed to weather those challenges. This plan ensures that we will continue have a viable program in the short-term, allowing us to work together with the administration, hospitals, and other stakeholders in making the program stronger and more stable for the long-term.”

Efforts to repair the Health Safety Net and rescue hospitals from bearing its unsustainable funding shortfalls have been ongoing throughout 2025. While the legislature and governor last month passed short-term funding targeted at safety net-related funding gaps for FY25, the latest plan is forward-looking to FY26 and FY27.

“The amendment passed by the House as part of the closeout budget is of critical importance to our commonwealth’s health safety net and hospitals’ ability to keep patient care services online in what will be a tumultuous few years ahead,” said MHA President and CEO Steve Walsh. “This plan is the result of a strong partnership between the Healey-Driscoll administration, the legislature, and the hospital community to secure federal support for uninsured and underinsured individuals before tens of thousands of people in Massachusetts lose health coverage in early 2026.” Walsh thanked House Speaker Ron Mariano, Ways & Means Chair Aaron Michlewitz, Health Care Finance Chair Lawn, and members of the House for advancing the proposal.

MHA Releases Updated Safety & Violence Prevention Guidelines

Building on its nationally recognized 2019 violence prevention guidance, MHA last week released an updated version of the document that offers newly revised strategies for a comprehensive approach to healthcare safety and violence prevention across healthcare facilities, including emergency departments, inpatient settings, outpatient clinics, mobile health services, and home healthcare.

The 40-page Guidelines for Healthcare Safety and Violence Prevention provides detailed information to assist facilities to strengthen and sustain safety oversight teams, offer training and education, collect and use data on incidents of violence, review and improve the physical layout of facilities, weave safety and violence prevention throughout clinical practice, and more.

In response to the increased risk of violence in healthcare settings, MHA formed a Healthcare Safety and Violence Prevention Workgroup composed of a diverse group of healthcare professionals. In 2019, the workgroup developed the guidance document to help healthcare facilities use evidence-based practices to create effective healthcare violence prevention programs. The updated version of that document adopts a health equity framework; expands the focus to include additional care settings; updates strategies to address caring for special populations, including patients with dementia, those on the autism spectrum, and those with other developmental disabilities or behavioral health conditions; includes new standards from the Joint Commission; incorporates principles of trauma-informed care; emphasizes support for victims; and includes a new focus on workforce wellbeing.

Every 36 minutes, a worker in a Massachusetts hospital is subject to an act of violence or a threat. This crisis has grown at an alarming rate in recent years, with healthcare workers experiencing a violent incident at least five times more often than the average private sector worker.

MHA, through the guidance of its Healthcare Safety and Violence Prevention Workgroup, and through the input of its membership and Board of Trustees, has responded to this troubling trend in a variety of ways. MHA created a survey to track the frequency, location, and types of violence committed on hospital campuses; issued an MHA Board of Trustees-approved united set of principles for patient-visitor codes of conduct; provides regular education opportunities to disseminate safety and violence prevention strategies from local and national leaders; and has joined with the Massachusetts Nurses Association and 1199SEIU Massachusetts to push for passage of H.2655/S.1718, An Act Requiring Health Care Employers to Develop and Implement Programs to Prevent Workplace Violence, now pending at the State House.

Uncertainty Over DSH Cuts Looms

The Medicaid disproportionate share hospital (DSH) program, in existence since 1981, is a key component of the national healthcare system as it provides funding to support hospitals providing care to a large volume – that is, a “disproportionate share” – of patients on Medicaid or without health insurance.

When the Affordable Care Act was passed in 2010 it was assumed that increased health insurance coverage would occur, which in turn would lessen and eventually eliminate the need for the DSH support. DSH cuts were scheduled to begin in 2014, but the need to support care to the uninsured remained, as did the cost of providing care – which is often under-reimbursed – to an increasing number of Medicaid patients. Therefore, Congress, acting in a bipartisan manner beginning in 2014, regularly delayed the planned cuts, which total $8 billion a year for three years running.

The 11-year-long moratorium on the DSH cut was included once again in the Continuing Resolutions (CR) that both the Republicans and Democrats put forth last month. Failure to pass that CR led to the current government shutdown and with it the enactment of the oft-delayed DSH cut. Effective October 1, CMS technically reinstated the first $8 billion cut although it has not yet released the details of how it will implement the cut.

Without the moratorium, Massachusetts would lose 85.7% of its Medicaid DSH allotment, or $786.3 million, according to the Medicaid and CHIP Payment and Access Commission (MACPAC). In previous government shutdowns, DSH payments were often restored retroactively once a funding agreement was reached. However, there is no guarantee that Congress will take similar action this time. Because of the special circumstances in which Massachusetts receives the DSH funding – that is, through the current Medicaid waiver – it appears that the commonwealth is not immediately at risk if the $8 billion cut does begin. At this point, the DSH dilemma is just another potentially destructive storm on the horizon.

Medicare Open Enrollment Begins; MHA Brochure Helps Explain Choices

Medicare open enrollment began on October 15 and runs through December 7. During this time, beneficiaries can switch between traditional Medicare and Medicare Advantage, change or add prescription drug plans, or adjust their coverage to better fit their needs. Any changes made during open enrollment take effect January 1, 2026.

The enrollment process has often been and continues to be confusing for patients and their families. Medicare Advantage options differ depending on where a beneficiary lives and which clinicians, hospitals, nursing homes, long-term care facilities, or home care services they go to for their care. It can be complicated for patients to compare the costs and benefits of Medicare Advantage options with traditional Medicare and to figure out whether a prescription drug plan or Medigap plan is necessary.

Last week, MHA sent to its membership a Medicare open enrollment summary document that lays out the basics of the process. It lays out the differences between traditional Medicare and Medicare Advantage, what patients should be aware of when choosing between the two, and where to seek further assistance on the subject. The document was prepared at the request of several MHA members who sought help in their outreach to patients and their families. It spotlights the Serving the Health Information Needs of Elders (SHINE) program as an especially important resource for patients seeking further information, counseling, and assistance.

House Bill Contains Move to Advance NLC

The supplemental budget that the House passed last week (see story above) authorizes federal background checks on any nurse registering for the Nurse Licensure Compact (NLC), which was enacted last November. Such background checks are an essential step to make the compact fully operational in Massachusetts. Earlier this year, the Massachusetts Board of Registration in Nursing put out this memo explaining the steps needed in order for the implementation process to begin.

Following years of advocacy from the hospital community, the state legislature last year made Massachusetts the forty-second state/jurisdiction to join the NLC. The compact allows qualified nurses to hold one multistate license with the ability to practice in all other “compact states,” eliminating the arduous re-licensure process and easing workforce shortages.

The Joint Commission in its 2026 National Performance Goals that will go into effect on January 1 also requires hospitals to obtain criminal background checks on staff when required by state law or hospital policy.

Transitions

Amy Rosenthal, who has served as the executive director of Health Care For All (HCFA) since 2017, will join the Executive Office of Health and Human Services (EOHHS) as Undersecretary of Health, effective November 17. A strong patient advocate and knowledgeable healthcare leader, Rosenthal ensured that HCFA under her leadership was a part of nearly every healthcare conversation in the state involving access, quality, cost, and more. HCFA was especially successful in the outreach effort that occurred during the MassHealth redetermination process; the state’s healthcare system will require a similar coordinated outreach to maintain access for people who will lose coverage in the coming years under the One Big Beautiful Bill Act. Rosenthal holds a bachelor’s degree in organizational studies from Northwestern University, a master’s degree in public health from Harvard University, and a master’s degree in public affairs from Indiana University.

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Joe-Ann Fergus, R.N., PhD, has been appointed executive director of the Massachusetts Nurses Association (MNA). She succeeds Julie Pinkham, R.N., who led MNA for more than two decades before retiring in May 2025. Since then, the union has been led by Interim Executive Director Roland Goff. Fergus has held multiple leadership roles with the MNA over the past 20-plus years. She earned a PhD in Nursing/Public Policy from UMass Boston, an MA in Dispute Resolution, and a BSN from Simmons.

John LoDico, Editor