The MassHealth Waiver 2016–2022: Delivering Reform

Thursday, January 5, 2017
Cover of MassHealth waiver report
Rachel Gershon, JD, MPH
Commonwealth Medicine
Michael Grenier, MPA
Commonwealth Medicine
Robert W. Seifert, MPA
Commonwealth Medicine

This issue brief describes the key elements of the most recent MassHealth 1115 waiver extension, including the shift to a delivery system centered on Accountable Care Organizations and Community Partners, a Delivery System Reform Incentive Program, the redesigned Safety Net Care Pool, and the expansion of services for treatment of substance use disorders. It concludes with a discussion of implications of the new system for major stakeholder groups.

Since its launch in 1997, the MassHealth 1115 Demonstration Waiver has served as a vehicle for expanding coverage, encouraging better coordination and cost containment through managed care, and supporting safety net providers. On Nov. 4, 2016, the federal Centers for Medicare and Medicaid Services (CMS) approved the sixth extension of the waiver. This extension seeks to transform the delivery of care for most MassHealth members and to change how that care is paid for, with the goals of improved quality and greater control over spending. The waiver also responds to the epidemic of opioid drug use in Massachusetts.