Overview
Section 1115 demonstration waivers allow states additional flexibility to design and improve their programs with CMS approval of experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and Children’s Health Insurance Program (CHIP) programs. 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 reform the way that care is delivered.
On September 28, 2022, the Centers for Medicare & Medicaid Services (CMS) approved Massachusetts’ request to extend the MassHealth Section 1115 Demonstration Waiver (MassHealth 1115 Demonstration) through December 2027. The 2022-2027 1115 MassHealth Demonstration will continue improving health outcomes and closing health disparities for members, in concert with other MassHealth efforts.
This page is dedicated to the 2022-2027 Demonstration. Previous demonstration periods can be found here: Historic 1115 Demonstration Waiver Documents
Current MassHealth 1115 Demonstration Documents
- Waiver and Expenditure Authorities, approved 6/25/24 PDF | Word
- Special Terms and Conditions (STCs), approved 6/25/24 PDF | Word
- STC Attachments
- Attachment A. Preparing the Evaluation Design, CMS resource: PDF | Word
- Attachment B. Preparing the Interim and Summative Evaluation Reports, CMS resource: PDF | Word
- Attachment C. Cost-Sharing, approved 5/30/24: PDF | Word
- Attachment D. SUD Health IT Plan, approved 3/1/23: PDF | Word
- Attachment E. Safety Net Care Pool Payments, approved 5/19/23: PDF | Word
- Attachment F. SMI/SED Implementation Plan, approved 3/1/23: PDF | Word
- Attachment G. SUD and SMI/SED Monitoring Protocol, approved 11/3/23 - Part A: XLS Part B: PDF | Word
- Attachment J. Hospital Quality and Equity Initiative (HQEI) Implementation Plan, PY1 approved 5/30/24: PDF | Word
- Attachment K. Monitoring Protocol for Other Policies (Reserved)
- Attachment L. Pricing Methodology for Accountable Care Organizations (ACOs) and Managed Care Organizations (MCOs), approved 6/21/23: PDF | Word
- Attachment M. DSRIP Protocol, approved 6/21/23: PDF | Word
- Attachment N. Safety Net Hospital Provider Payment Eligibility and Allocation Protocol, approved 3/29/23: PDF | Word
- Attachment P. Health Related Social Needs (HRSN), approved 7/15/24; PDF | Word
- Attachment Q. Medicaid Managed Care Entity/ACO Performance-Based Payment, Mechanisms , approved 5/19/23: PDF | Word
- Attachment R. DSRIP Flexible Services Protocol, approved 9/2/21: PDF | Word
- Attachment S. Evaluation Design Document, approved 1/18/24: PDF | Word
- Attachment T. Health Related Social Needs (HRSN) Implementation Plan, approved 6/12/23: PDF | Word
- Attachment U. Primary Care Payment Protocol (Reserved)
- Attachment V: Medicare vs. Medicaid Provider Rate Attestation Table, approved 11/22/23: PDF | Word
- Attachment W. Reentry Services, approved 4/30/24: PDF | Word
- Attachment X. Reentry Implementation Plan, submitted to CMS on 8/16/24 and still under CMS review: PDF | Word
- Attachment Y. Reentry Reinvestment Plan (Reserved)
- Attachment Z: DSHP List, approved 6/25/24: PDF | Word
- Attachment AA. DSHP Claiming Protocol, approved 7/31/24 PDF
- Attachment BB. DSHP Sustainability Plan (Reserved)
2024
MassHealth 1115 Demonstration Amendment Request as Posted for Public Comment
Posted for Public Comment October 11, 2024 – November 12, 2024
- Demonstration Amendment Request: PDF | Word
- Public Notice: PDF | Word
- Fact Sheet: PDF | Word
- Budget Neutrality Workbook: PDF | Excel
- MassHealth 1115 Demonstration Amendment Request as Posted for Public Comment: PDF | Word
Approval of MassHealth 1115 Demonstration Amendment Request
Submitted May 3, 2024. Approved June 25, 2024
- 1115 Demonstration Amendment Approval Letter: PDF
- Waiver and Expenditure Authorities: PDF| Word
- STCs: PDF | Word
- Budget Neutrality Workbook: XLS
Submission of MassHealth 1115 Demonstration Amendment Request
Submitted May 3, 2024
- 1115 Demonstration Amendment Request submitted to CMS: PDF | Word
- Fact Sheet: PDF | Word
- Budget Neutrality Workbook: XLS | Word
Approval of MassHealth 1115 Demonstration Amendment Request
Submitted October 16, 2023, Approved April 19, 2024
- 1115 Demonstration Amendment Approval Letter: PDF | Word
- Waiver and Expenditure Authorities: PDF | Word
- STCs : PDF | Word
- Budget Neutrality Workbook: XLS
MassHealth 1115 Demonstration Amendment Request As Posted for Public Comment
Posted for Public Comment March 27, 2024 – April 26, 2024
- 1115 Demonstration Amendment Request: PDF | Word
- Public Notice: PDF | Word
- Fact Sheet: PDF | Word
- Budget Neutrality Workbook: PDF | Excel
- Public Comments to Proposed MassHealth 1115 Waiver Amendment Request: PDF | Word
Other 2024 Demonstration Activity
Approval of Certified Public Expenditure (CPE) Methodology
On September 30, 2024 CMS approved MassHealth’s CPE Methodology for the MassHealth Temporary Housing Assistance for Families and Pregnant Individuals Program: PDF | Word
Public Meeting on MassHealth 1115 Demonstration and Delivery System Restructuring Progress
On March 1, 2024, MassHealth held a public meeting to present the annual report on the progress of delivery system restructuring efforts and the Delivery System Reform Incentive Program (DSRIP) for calendar year 2021, as well as to provide an opportunity for the public to comment on the progress of the current 1115 MassHealth Demonstration. Stakeholders will have an opportunity to ask questions and provide feedback. Please see 1115 Demonstration ("Waiver") Reports | Mass.gov for the most recent Annual Report on the 1115 Demonstration.
Reasonable Accommodation: If you require an ADA accommodation, please contact 1115 WaiverComments@mass.gov.
Community Feedback Forum for Health and Justice
On January 29, 2024, MassHealth posted a Notice of Opportunity (NOO) to solicit stakeholders to participate in MassHealth's Community Feedback Forum for Health & Justice. This Forum will advise EOHHS on key policy decisions related to the request for and implementation of its 1115 Demonstration initiative to cover certain MassHealth services for eligible individuals who are incarcerated in a Massachusetts Department of Corrections, County Correctional, or Department of Youth Services facility in the 90-day period before the individuals are released from incarceration.
MassHealth has again updated its Notice of Opportunity (NOO) to participate in MassHealth's Community Feedback Forum for Health & Justice. The update to the NOO extends the deadline for applications until April 30, 2024, at 4 p.m.
More details can be found in the attached documents, or on COMMBUYS at this link or by searching the keywords “Community Feedback Forum.”
2023
Submission of MassHealth 1115 Demonstration Amendment Request
Submitted October 16, 2023
- 1115 Demonstration Amendment Request Submitted to CMS: PDF | Word
- Fact Sheet: PDF | Word
- Budget Neutrality Workbook Submitted to CMS: PDF | Excel
- Public Comments to Proposed MassHealth Section 1115 Demonstration Amendment Request: PDF | Word
MassHealth 1115 Demonstration Amendment Request As Posted for Public Comment
Posted for Public Comment August 2,2023 – September 9, 2023
- 1115 Demonstration Amendment Request: PDF | Word
- Public Notice: PDF | Word
- Fact Sheet: PDF | Word
- Budget Neutrality Workbook: PDF | Excel
Approval of Technical Corrections for Demonstration Extension
Approved June 21, 2023
2022
Approval of MassHealth 1115 Demonstration Extension
Approved September 28, 2022
- 1115 Demonstration Approval Letter: PDF | Word
- 1115 Demonstration Approval Fact Sheet: PDF | Word
- 1115 Demonstration Extension Summary: PDF | Word
For more information about the request to extend the 1115 Demonstration, please see: 1115 MassHealth Demonstration ("Waiver") Extension Request
| Last updated: | November 14, 2024 |
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