The Commonwealth of Massachusetts Executive Office of Health and Human Services One Ashburton Place, Room 1109 Boston, Massachusetts 02108 DEVAL L. PATRICK Governor TIMOTHY P. MURRAY Lieutenant Governor JOHN W. POLANOWICZ Secretary June 4, 2013 Marilyn Tavenner Administrator Centers for Medicare and Medicaid Services U.S. Department of Health and Human Services 200 Independence Avenue, S.W., Room 314G Washington, D.C. 20201 Re: Request to Amend Massachusetts' Section 1115 Demonstration: MassHealth (l1-W-00030/l) Dear Administrator Tavenner: In my capacity as Secretary of the Executive Office of Health and Human Services for the Commonwealth of Massachusetts, I am submitting to the Centers for Medicare and Medicaid Services (CMS) a request to amend the Massachusetts Section 1115 Demonstration Project (11-W-00030/l). The amendment implements provisions of the Affordable Care Act (ACA), including the Medicaid expansion for adults up to 133 percent of the Federal Poverty Level (FPL). In order to align with changes under the ACA, Massachusetts will make a number of changes to eligibility and benefits currently authorized in Demonstration programs. In addition, through the amendment we request expenditure authority to support premium assistance payments as part of the Commonwealth's "State Wrap" - a state subsidy to be offered to individuals with incomes up to 300 percent FPL purchasing insurance through the state Exchange. These subsidies will supplement federal Advance Premium Tax Credits in order to preserve Massachusetts' historic insurance coverage expansion, which was based on affordability levels established in the Commonwealth Care program. The amendment request also includes proposals to advance delivery system transforn1ation, payment reform and cost containment. Central to these goals is the Primary Care Payment Reforn1 Initiative, an alternative payment methodology that increases care coordination, reduces costs, and shares savings. Thank you for your consideration of this amendment request. We look forward to partnering with CMS as we continue to advance our shared goals for health care reform. Sincerely, John Polanowicz Secretary, Executive Office of Health and Human Services cc: Cindy Mann Rich McGreal Julie McCarthy Jennifer Sheer