Press Release  Healey-Driscoll Administration Posts for Public Comment an Amendment to MassHealth’s 1115 Demonstration to Improve Access to Care and Advance Health Equity

BOSTON — Today, the Healey-Driscoll Administration posted a request for public comment that will be submitted to the Centers for Medicare and Medicaid Services (CMS) for proposed changes to MassHealth’s Section 1115 Demonstration (“1115 Demonstration”). The amendment aims to advance health equity by expanding coverage to targeted populations and further address members’ health-related social needs.  

The Massachusetts 1115 Demonstration is currently approved through December 2027 and supports the Commonwealth’s commitment to universal health care coverage and has provided federal authority to test innovations in payment and care delivery. The current waiver includes continuous eligibility for justice-involved members and chronically homeless members under the age of 65, and MassHealth intends to implement continuous eligibility for children up to age 19 beginning in January 2024.  

The proposed amendment would expand continuous eligibility to all adult members over the age of 19 and chronically homeless members aged 65 and older for 12 and 24 months respectively. It would also include 90 days of pre-release MassHealth coverage for justice-involved individuals and state subsidies for an increased number of individuals who purchase insurance through the Health Connector. 

“This 1115 Demonstration amendment reinforces Massachusetts’ commitment to delivering high-quality and equitable care for all Massachusetts residents by reducing the risk of gaps in health care coverage,” said Secretary of Health and Human Services Kate Walsh. “I am grateful to CMS, the MassHealth team, and our partners for their commitment to improving health outcomes for all members, especially those who have been historically left out and marginalized.” 

“The proposed 1115 Demonstration amendment requests build directly upon existing efforts to advance health equity and ensure Massachusetts residents remain universally insured,” said Assistant Secretary for MassHealth Mike Levine.  “I look forward to partnering closely with providers, plans, members, and CMS as we work to finalize the amendment and implement these important reforms.” 

MassHealth intends to request authority through this amendment to implement the following changes:   

1. Provide Pre-Release MassHealth Services to Individuals in Certain Public Institutions 

MassHealth is proposing to provide certain MassHealth covered services to otherwise eligible individuals for up to 90 days prior to release, including justice-involved youth in Department of Youth facilities, to address health inequities experienced by justice-involved populations. 

2. Provide 12 Months Continuous Eligibility for All Adults and 24 Months Continuous Eligibility for Members Experiencing Homelessness Who Are 65 and Over   

MassHealth is proposing to extend 12 months of continuous eligibility to all adults aged 19 and over. Continuous eligibility for children under age 19 is already slated to begin in January of 2024, and this amendment would extend 12 months of continuous eligibility to all MassHealth members.. The amendment would also extend the 24 months of continuous eligibility for members experiencing homelessness under age 65 to those age 65 and over. Continuous eligibility means members will retain coverage for the appointed period even if they experience changes in their circumstances that would otherwise affect eligibility. 

3. Implement Three Months Retroactive Eligibility  

MassHealth is proposing to implement three months of retroactive coverage from the day of application for all members.   

4. Expand Marketplace (Health Connector) Subsidies to Additional Individuals 

The Commonwealth is requesting an expansion of its existing 1115 Demonstration expenditure authority for marketplace subsidies for ConnectorCare premiums to include eligible individuals up to 500% of the Federal Poverty Level (FPL), consistent with potential changes to state law. 

5. Include Short-Term Post Hospitalization Housing (STPHH) and Supportive Services as an Allowable Health Related Social Needs service  

MassHealth is proposing coverage for up to six months of Short-Term Post-Hospital Housing (medical respite) as a Heath Related Social Needs service. Through this amendment, MassHealth seeks to ensure that MassHealth members experiencing homelessness are discharged from hospitals to a safe space and avert further intensive medical interventions and reduce the total cost of care. 

6. Increase the Expenditure Authority for the Health-Related Social Needs Integration Fund  

MassHealth is proposing to allocate additional funding up to $25M for infrastructure investments. MassHealth’s current 1115 Demonstration includes authority for $8M of infrastructure investments for organizations providing Health Related Social Needs Services to MassHealth members. 

7. Increase the Income Limit for Medicare Savings Program (MSP) Benefits for Members on MassHealth Standard to the State Statutory Limit   

MassHealth is proposing to extend the Medicare Savings Program by tying federal eligibility to the income limit in state law, meaning that more low-income individuals would qualify for assistance in paying for their Medicare premiums.  

8. Preserve CommonHealth Members’ Ability to Enroll in One Care Plans  

MassHealth is proposing to seek clarification of demonstration authority to continue to allow CommonHealth members, post 1/1/26, to be enrolled in One Care as their delivery system for Medicaid coverage.   

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