On March 11, 2021, President Biden signed into law the American Rescue Plan Act. Section 9817 provides enhanced federal funding for Medicaid home and community-based services (HCBS) and certain behavioral health services through a one-year 10% increase to the share of state Medicaid spending that is paid for by the federal government. This one-year increase in federal matching funds would result in new, time-limited dollars that can be invested in certain Medicaid HCBS and behavioral health services through March 2024. These services strive to enhance the quality of life and independence of people in their home and community. This is an exciting opportunity to further strengthen such services.
The Executive Office of Health and Human Services provided initial information about its strategy on March 31, 2020 here.
EOHHS welcomes community feedback on ways to enhance, expand, and strengthen Medicaid home and community-based services (HCBS) and certain behavioral health services through one-time and tie-limited investments. This section will continue to be updated with notices, meeting information, and documents related to community input.
EOHHS encourages community members to submit questions and comments directly to firstname.lastname@example.org.
EOHHS first met with the HCBS and behavioral health community about the American Rescue Plan Act on Wednesday, March 31, 2021.
On April 16, 2021, the Commonwealth issued a Request for Information (RFI) to gather community feedback on strategic areas for investment. Responses were due May 7, 2021. The Commonwealth received 203 proposals in response to the RFI. A summary document of the responses is posted below.
EOHHS met again with the HCBS and behavioral health community on June 8, 2021 to provide an overview of the Initial Spending Plan and the steps that are being taken to enhance, expand and strengthen HCBS.
Most recently, EOHHS met with the HCBS and behavioral health community on July 16, 2021 to share additional details on the implementation of funding for time limited rate enhancements outlined in the Initial Spending plan, provide a high-level overview of investments included in the July Quarterly Spending plan and communicate next steps leading up to the October Quarterly Spending plan.
Public Discussion Forums
EOHHS hosted a series of public forums providing an opportunity for Stakeholders to engage on key topics, themes and issues related to investments contemplated for inclusion in the October Quarterly spending plan. Materials shared during these forums can be accessed by clicking on the links below:
Massachusetts Spending Plans and Narratives
Initial Spending Plan and Narrative (Round 1 Investments)
On June 17, 2021, the Executive Office of Health and Human Services (EOHHS) submitted to the federal Centers for Medicare and Medicaid Service (CMS) its initial spending plan to enhance, strengthen, and expand Medicaid (MassHealth) home and community-based services using an anticipated $525 million in estimated net new, time-limited enhanced federal dollars that can be invested in home and community-based services through March 2024. The initial spending plan proposes a phased approach in which EOHHS will finalize initiatives over three “rounds”. The June 2021 Initial Spending Plan includes investments totaling $338M gross ($133M net).
EOHHS’s initial spending plan incorporates stakeholder feedback to outline a strong framework to enhance, strengthen and expand home and community-based services (HCBS) across MassHealth populations both immediately and in the long-term
Use of enhanced federal funding will reinforce the Commonwealth’s commitment to improve equity and access to HCBS for those with physical disabilities, intellectual and developmental disabilities, and behavioral health needs. To achieve these goals, the Commonwealth of Massachusetts will implement initiatives supporting three key structural pillars:
- HCBS Workforce, retaining and building a high-quality network;
- Access to and Promotion of HCBS Services and Supports, including navigation, transitions, family supports, diversion and enhanced care models; and
- HCBS Technology and Infrastructure, to enable more effective care coordination, access, and delivery.
Massachusetts’s will implement three rounds of initiatives. Round 1 will invest approximately $100M of the enhance federal funding in immediate time limited across-the-board payment enhancements to strengthen and stabilize the HCBS workforce.
- Summary of the Initial Spending Plan & Narrative: Word Doc | PDF
- Initial Spending Plan & Narrative submitted to CMS on June 17, 2021: Word Doc | PDF
To implement the immediate time limited across-the-board payment enhancements for the HCBS workforce included in Round 1, EOHHS filed regulations under emergency adoption, 101 CMR 447.00: Rates for Certain Home- and Community-based Services Related to Section 9817 of the American Rescue Plan Act. The time-limited rate enhancements are effective July through December 2021 with the goal of strengthening and stabilizing the state’s HCBS workforce in response to the COVID-19 public health emergency.
- 101 CMR 447.00: Rates for Certain Home- and Community-based Services Related to Section 9817 of the American Rescue Plan Act
Information regarding the allowable use of this enhanced funding can be found below. EOHHS agencies will issue additional guidance and information related to implementation in the coming days based on program/provider specific needs. Providers are encouraged to check this site regularly for updated information.
- For MassHealth Providers: Home and Community-Based Service Enhanced Rate Add-Ons using American Rescue Plan Act (ARPA) Funding
Providers will have until September 30th, 2022 to expend the funds. As a condition of receipt of these additional funds, eligible provider agencies must complete an attestation by December 31st, 2022 assuring EOHHS that they have used at least 90% of the funds for direct care workforce development, which could include hiring and retention bonuses and other categories of worker compensation. Additionally, provider agencies that receive enhanced funds are required to submit a spending report to EOHHS that accounts for how the enhanced funds were used by December 31st, 2022.
EOHHS has provided the attestation form and sample spending report below so that providers understand what they are committing to and what information needs to be reported, but the forms are not yet open for submission. EOHHS is working to procure a vendor to create a reporting and tracking portal to facilitate reporting requirements for these funds. The attestation form and spending reports will be available to providers through this reporting portal prior to the deadlines. Additional information regarding this initiative will be added to this page as available.
- HCBS ARPA Sample Attestation Form and Information (PDF) | (DOC)
- HCBS ARPA Sample Spending Report and Information (PDF) | (DOC)
Quarterly Spending Plan and Narrative
Round 2 Investments
On July 16, 2021, EOHHS submitted to CMS its first Quarterly Spending Plan and Narrative, which builds upon the Initial Spending Plan submitted on June 17, 2021.
The July 2021 Quarterly Spending Plan includes new investments totaling approximately $44M gross ($21M net) and complements Massachusetts’ long-standing commitment to equitably rebalancing long-term services and supports and behavioral health services towards community living by diverting and/or transitioning individuals away from facility-based settings. The investments detailed in the Quarterly Spending Plan are in addition to the $100M workforce investment detailed in the Initial Spending Plan.
- Summary of the July 2021 Quarterly Spending Plan & Narrative: Word Doc | PDF
- July 2021 Quarterly Spending Plan and Narrative submitted to CMS on July 16, 2021: Word Doc | PDF
Round 3 Investments
On October 15, 2021, EOHHS submitted to CMS its second Quarterly Spending Plan and Narrative, which builds upon the Initial Spending Plan submitted on June 17th, 2021 and the July Quarterly Spending Plan submitted on July 16th, 2021.
The October Quarterly Spending Plan includes the third and final round of investments totaling approximately $583M gross ($372M net) in initiatives with broad impact that span across the three “Home and Community First” pillars. Specific focus areas include strengthening the workforce, enhancing the HCBS system, equitable balancing towards community living and providing supports to members, families, and their natural supports.
With the submission of the October Quarterly Spending Plan outlining the third round of investments, EOHHS has committed to a total investment of $965M, using the enhanced federal funding, to enhance, strengthen, and expand HCBS across MassHealth populations.