Admin lays out strategy for next MassHealth waiver process


BOSTON (SHNS) – Gov. Charlie Baker and his health care team are preparing to submit a proposal to the federal government for a new five-year Medicaid waiver that would continue assessments on acute hospitals worth $1.5 billion to help pay for investments in health equity, behavioral health, primary care, and pediatrics.

The administration last week released a strategy document outlining how it will approach its proposal to the Centers for Medicare and Medicaid Service for what is known as an 1115 waiver, which allows states to tailor their Medicaid programs to achieve desired outcomes.

The new waiver request, according to the administration, will seek to continue to restructure MassHealth and use accountable care organizations to reward value-based care. It will also seek approval for investments in behavioral health and pediatric care, promote health equity and seek to streamline the delivery of care without jeopardizing the state’s near-universal coverage.

One new proposal calls for a $500 million initiative over five years for ACO-participating hospitals to measure and reduce health care disparities based on race, gender, ethnicity, disability or other factors. The waiver application is also expected to seek to continue to maintain health insurance subsidies for people earning up to 300 percent of the poverty level and to provide $515 million funding for hospitals over five years “tied to investments in the safety net supporting health equity.”

The investments would be paid for with the continued assessment of acute hospitals totaling $1.5 billion over five years. Massachusetts Health and Hospital Association Vice President Dan McHale said in a statement published Monday in the group’s weekly newsletter that the strategy offers a “strong foundation” for the waiver request. The group said hospitals support many of the priorities including three-month retroactive MassHealth coverage for pregnant women and children.

“We look forward to working with the agency and the Legislature to develop a formal proposal that recognizes the contributions of hospitals — especially safety net providers — and affords them the support they need to succeed over the next five years,” McHale said. The hospital association said it was working with the Executive Office of Health and Human Services to “align on a plan for the next iteration of the acute hospital assessment and its funding uses.”

listening session is planned by the administration on Tuesday at 10:30 a.m.

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