INSIDE THE ISSUE

> The MassHealth Waiver
> MA Repay
> Building the Workforce
> Violence Prevention Summit
> Paxlovid
> Hospital Charity Care

MONDAY REPORT

MassHealth Waiver Amendment Recognizes Migrant Issue

The amendment to the 1115 MassHealth Waiver that the state announced in August was formally filed last week with the federal Centers for Medicare and Medicaid Services (CMS). All requested changes to the waiver are subject to CMS approval.

MHA and its members supported the initial version of the amendment that, among other things, expanded continuous eligibility to all adults for one year – meaning their coverage remains even if their eligibility circumstances change during the year. The amendment also expanded subsidized coverage to cover more individuals and no longer limited retroactive coverage for any low-income residents that apply and become eligible for MassHealth.

Between August and the filing this month, the Executive Office of Health and Human Services (EOHHS) added other elements to the amendment request that MHA also supports. One such change relating to the recent influx of migrants allows the commonwealth to provide up to six months of temporary housing assistance and related support for families and pregnant individuals, including newly arrived immigrants, who are enrolled as MassHealth members.

“The commonwealth, like other states, has faced a recent influx of immigrants, including recent arrivals with an immigration status that entitles them to full Medicaid benefits,” EOHHS wrote in its waiver amendment request. “These new arrivals include, but are not limited to, Cuban/Haitian entrants, refugees, asylum seekers, and individuals granted parole into the United States for at least one year. These individuals are (or may be) enrolled in the full MassHealth benefit, yet they face significant challenges in obtaining housing while they await the issuance of work authorizations and related documentation. Additionally, in the absence of alternative housing solutions, some newly arrived immigrant MassHealth members have sought shelter in emergency departments, placing strain on healthcare providers.”

Under the waiver, MassHealth members would also be eligible to receive supportive services, including outreach, case management, and referrals to medical, social, and educational services from community-based providers qualified to meet the specialized needs of this population.

In a related item, MHA signed on to letters to the Biden Administration and to the Massachusetts Congressional delegation, seeking federal support for the migrant issue. The letters specifically ask for:

• expedited work authorizations that will “empower more work-eligible newcomers to become more self-sufficient sooner” and reduce their reliance on public resources;
• identification of federal properties that can be used as congregate housing sites; and
• federal funding for additional needs, such as healthcare and education, “to concrete items like diapers, baby formula, and clothing.”

New Round of MA Repay Funding; More to Come in 2023 and 2024

The Healey Administration has opened round two of the MA Repay program that will release $25 million for healthcare professionals who work for the Department of Mental Health (DMH) or who provide continuous skilled nursing (CSN) for MassHealth.

MA Repay was created at the end of 2022, using funding from the American Rescue Plan Act and the Opioid Recovery and Remediation Fund. The legislature in the FY2024 budget added an additional $120 million to the program. The Massachusetts League of Community Health Centers administers MA Repay. This past August, the state distributed $140 million from the program to 2,935 primary care and behavioral health providers. In announcing round two last week, the administration said two additional rounds of the program will be made available later in 2023 and in 2024.

Qualifying health professionals for the DMH-focused initiative include but are not limited to social workers, primary care physicians, psychiatrists, nurses, substance use recovery coaches, and case managers working in eligible settings. Loan repayment awards will range between $12,500 and $300,000 per individual depending on their occupation, academic degree level attained, and whether the individual works part-time or full-time. All DMH awardees must commit to four years of service. Loan repayment awards for the CSN-focused initiative will range between $10,000 and $35,000 per individual depending on whether the individual works part-time or full-time, their credentials, and the length of service obligation.

The deadline for the DMH applications is November 1; applications for the CSN funding will be accepted on a rolling basis. Full details are available here.

Hospital Groups Join New Healthcare Workforce Coalition

On October 18, a diverse coalition of national healthcare groups, including the American Hospital Association, announced the formation of the Healthcare Workforce Coalition to unite around a set of proposals to address the workforce shortage. The coalition stated it primary objectives are to:

• Increase student enrollment and improve the academic preparedness of healthcare students.
• Retain healthcare workforce.
• Attract international skilled healthcare workers.

The coalition will focus on advocacy and engaging with the media to help support solutions to the workforce shortage.

In Massachusetts, MHA has coordinating efforts among its membership to build the healthcare workforce. The successful Find Your Place social media campaign that ran through the summer and early fall highlighted healthcare as a place where people of all backgrounds can find purpose, growth, and a variety of fulfilling career opportunities – all while pointing viewers directly to healthcare job boards and career pages. Phase 2 of the campaign will involve creation of a dedicated “Find Your Place” website, among other actions.

MHA also launched its HEALTHCAREers Academy, a program focused on training the next generation of healthcare workers in high-need areas. Through the program, MHA works with community colleges to identify candidates to work in high-need areas of healthcare, facilitate their training with additional higher education institutions, and then connect them with healthcare organizations with open positions. The pilot program, funded through MHA scholarships, will train 10 Behavioral Health Technicians, who will be job-ready following their participation in the Academy.

MHA continues to work on and share strategies to retain the healthcare workforce through its standing councils and workgroups focused on healthcare safety and workforce wellbeing.

MHA Conference Focused on Violence Prevention

Among the noted topic areas for this year was the theme of redefining safety culture. Keynote speaker Ji Seon Song, assistant professor at the University of California Irvine School of Law, framed ethical considerations for equitable safety practices in healthcare settings.

“We are moving from zero tolerance to 100% response,” said Dr. Alison Duncan, medical director of the BMC Youth Community Behavioral Health Center at Boston Medical Center. She was on a panel discussing care for patients with specialized needs, such as neurodivergence and co-occurring medical and behavioral conditions.

Another panel focused on Behavioral Emergency Response Teams and Crisis Response Teams and featured (shown from left to right in the above photo) Kelsey Belgrade, director, Behavioral Health Training & Education, Franciscan Children’s; Rebecca Langlands, behavioral resource clinician, Baystate Medical Center; Kelcie Knowles, Behavioral Resource Team, Baystate Medical Center; and Scott Hemingway, director, Security and Parking, Signature Health. Bonnie Michelman, VP and chief security officer, Massachusetts General Hospital & Mass General Brigham moderated the panel, which covered the importance of recruiting and retaining multi-disciplinary staff to meet the needs of patients and providers when confronting crisis incidents across facilities.

In a Q&A session, attendees began a particularly timely conversation around caregivers’ reluctance to pursue legal action when they are assaulted – specifically because they often must provide their home address to authorities throughout the process. MHA’s priority legislation, An Act Requiring Health Care Facilities to Develop & Implement Programs to Prevent Workplace Violence (H.2381/S.1538) would, among other things, allow healthcare professionals to use the address of their employer or labor union within legal proceedings. State lawmakers held a hearing on the bills earlier this month.

Paxlovid to Transition to Commercial Market; Price Increases

U.S. Health & Human Services announced recently that Paxlovid, the five-dose Pfizer regimen that reduces death and hospitalization in people that contract COVID-19, will transition to the commercial market in November 2023.

Then, last Thursday, Pfizer announced that it will more than double the cost of the drug from what the government had been paying during the pandemic. The new base price for Paxlovid will be $1,390, up from $529. That base price will be the starting point of negotiations between Pfizer and insurers, which in turn will determine the cost of the drug to those who have commercial insurance.

According to HHS, “Individuals on Medicare, Medicaid, and those who are uninsured will continue to be able to access HHS-procured Paxlovid for free through the end of 2024 via a patient assistance program. From 2025-2028, Pfizer will continue to run a patient assistance program for individuals who are uninsured or underinsured with HHS-procured Paxlovid. In parallel, Pfizer will operate a copay assistance program for individuals with commercial insurance through 2028.”

Hospitals Upholding Commitment to Communities

Last week, the American Hospital Association reported results of an analysis conducted in conjunction with Ernst & Young LLP, which shows that tax-exempt hospitals provided more than $130 billion nationally in charity care and related benefits to their communities in FY2020.

In Massachusetts, the Attorney General’s office last week released the most recent community benefits report (FY2022), showing that hospitals contributed $904 million in assistance to the communities they serve – a marked increase over the previous fiscal year. The IRS allows hospitals to count financial losses related to care provided to Medicaid recipients, along with medical education costs and other metrics as community benefits. By including those metrics, the IRS in FY2021 (the most recent year) calculated Massachusetts hospital community benefits at more than $3.5 billion.

John LoDico, Editor