The MassHealth Proposed Demonstration Extension 2022-2027: Building on Success, Focusing on Equity

Authors: The Blue Cross Blue Shield of Massachusetts Foundation, The Massachusetts Medicaid Policy Institute, and Commonwealth Medicine Division, UMass Chan Medical School
Year: 2022
State: NatDoc: National Document
Website link:
Publicly Available: Yes
Policy: Building partnerships, General other, Legislative language
Sustainable Financing: How to engage and work with Medicaid, Billing/CPT codes, MCO or bundled payment reimbursement models, Reimbursement TA for FQHCs Medicaid etc., Documentation of how CHWs can work within care teams

MassHealth is Massachusetts’ combined Medicaid program and Children’s Health Insurance Program (CHIP), providing coverage to more than one in four Massachusetts residents. Each state runs its own Medicaid program and those programs must meet certain federal standards unless the state obtains a “demonstration waiver” from the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees Medicaid. Demonstration waivers must be renewed (or“extended”) periodically (typically every 5 years). Massachusetts administers much of MassHealth under a “demonstration waiver” (referred to in this report as the Demonstration), which it has extended several times since it was originally approved in 1995. On December 22, 2021, Massachusetts submitted to CMS a request to extend its demonstration once again. The request unveiled Massachusetts’ vision for MassHealth over the next five years, including many new initiatives. Health equity took center stage in the Demonstration request, informing the vision and new initiatives. This report describes the proposed MassHealth Demonstration extension, what it means for MassHealth coverage moving forward, and implications for members, providers, and Massachusetts.

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