Massachusetts Introduces New Medicaid Rules

March 2018 ~

Massachusetts’ Medicaid program, MassHealth, has implemented major changes to the structure of the program, including shifting to accountable care organizations, allowing health care providers to address social determinants of health, and reimbursements will be tied to provider performance.

In what is being called the biggest redesign of the Massachusetts Medicaid program in over two decades, as of March 1st over 800,000 Massachusetts Medicaid recipients will be assigned new insurance plans, a large majority of which have been assigned to accountable care organizations (ACOs).

MassHealth members will now be automatically enrolled in one of 17 ACOs based on their primary care provider, and will be able to change their plan for any reason for 90 days.

Members who opt out of the ACOs can instead choose to enroll in one of two managed care organizations, which together will cover between 150,000 and 200,000 members, or MassHealth’s primary care clinician plan, also expected to cover between 150,000 and 200,000 members.

Health and Human Services Secretary, Marylou Sudders, says the restructuring of the MassHealth program has been planned for years and will help eliminate confusion among different providers who may care for a patient.

For more information on these changes, visit MassHealth’s informational page.


Source(s): Kaiser Health News; WBUR; Boston Globe;