| The MassHealth program, which has 1.8 million members in Massachusetts, would be restructured toward the accountable care model of service delivery under a five-year deal with the federal government proposed Wednesday by the Baker administration.
Federal authorization and funding for key aspects of the state’s current MassHealth program – jointly funded by the state and federal governments – expire on July 1, 2017, and the state is at risk of losing more than $1 billion a year if its waiver agreement is not renegotiated.
The Baker administration is seeking from President Barack Obama’s administration a new five-year waiver extension – from July 2017 through June 2022 – that they hope will lead to the first fundamental course shift in 20 years for MassHealth and more sustainable growth in a $15 billion program that consumes 40 percent of the state budget, denying funds for other worthwhile public services.
The waiver request calls for $1.8 billion in upfront investments in the accountable care organization (ACO) model, including funding for behavioral health and long-term care service providers.
State officials see the ACO model, which emphasizes integrated and coordinated care and holds providers accountable for care quality and cost, as in keeping with the 2012 health care quality and costs containment law that called for a move away from fee-for-service models and “fragmented care.”
Politics could come into play with the 92-page waiver request since the Baker administration is looking to strike a major new deal with the federal government just months before the White House changes hands and Obama leaves office after an eight-year run.
The waiver request will be submitted to the Centers for Medicare and Medicaid Services, which is overseen by U.S. Health and Human Services Secretary Sylvia Mathews Burwell. A former director of the federal Office of Management and Budget, Mathews Burwell previously worked at McKinsey & Co., as president of the Walmart Foundation, and as president of the Global Development Program at the Bill & Melinda Gates Foundation.
Medicare is also moving away from a system in which it pays for each service a physician provides and towards a system that rewards physicians for coordinating with each other as they would in the ACO model.
State officials have opened a one-month comment period on their waiver request, ending on July 15, with two public hearings scheduled to accept feedback on the proposal. A 2:30 p.m. hearing is planned for Friday, June 24 at One Ashburton Place in Boston, followed by a 2 p.m. hearing on Monday, June 27 at the Fitchburg Public Library.
