On December 22, 2021, the Massachusetts Executive Office of Health and Human Services (EOHHS) submitted a request to extend the MassHealth Section 1115 Demonstration (“1115 waiver”) to the Centers for Medicare and Medicaid Services (CMS).
Since 1997, the MassHealth 1115 demonstration has been a critical tool in enabling Massachusetts to achieve and maintain near-universal coverage, sustain the Commonwealth’s safety net, expand critical behavioral health services, and implement reforms in the way that care is delivered.
Under the current 1115 waiver, the Baker-Polito administration implemented the most significant delivery system reforms for MassHealth members in over two decades, restructuring the delivery system towards integrated, value-based care through Accountable Care Organizations (ACOs); improving integration of physical health, behavioral health, and long-term services and supports; and, addressing the opioid crisis through expanded access to a broad spectrum of recovery-oriented substance use disorder services.
To further improve health outcomes and close health disparities, MassHealth’s 1115 waiver extension proposal submitted to CMS focuses on five goals:
- Continue the path of restructuring and reaffirm accountable, value-based care – increasing expectations for how ACOs improve care and trend management, and refining the model.
- Make reforms and investments in primary care, behavioral health, and pediatric care that expand access and move the delivery system away from siloed, fee-for-service health care.
- Advance health equity, with a focus on initiatives addressing health-related social needs and specific disparities, including maternal health and health care for justice-involved individuals.
- Sustainably support the Commonwealth’s safety net, including ongoing, predictable funding for safety net providers, with a continued linkage to accountable care.
- Maintain near-universal coverage including updates to eligibility policies to support coverage and equity.
In the coming months, EOHHS will work closely with CMS and anticipates approval for the 1115 waiver in mid-2022. The 1115 waiver extension request, and all attachments submitted to CMS, can be found at: https://www.mass.gov/info-details/1115-masshealth-demonstration-waiver-extension-request