Initial Medicaid Implementation: Prior to the implementation of the Medicaid program, Massachusetts operated a comprehensive benefit program that covered low-income seniors under the Kerr-Mills legislation. Massachusetts initially began the state’s Medicaid program in September of 1966 becoming the 23rd state to implement the program. When the program began, it was estimated that approximately 7% of Massachusetts residents would be eligible for Medicaid in the first few years that the program was implemented. In 1968 the federal government proposed reducing the matching rate for wealthier states which would have led to $40 million less in federal dollars for Massachusetts. In response to fiscal pressures in 1969 the governor reduced eligibility levels through executive order. One of the main issues in the early years of Medicaid implementation in the state was how providers would be paid. The Massachusetts Medical Association objected to the new payment paperwork designed to work with the new computing system. Physicians also argued for Blue Shield to be the fiscal agent for the program.
Key Medicaid Political Issues: The state has had a history of adopting broad health care reforms. In 1988, then governor Michael Dukakis signed the Health Security Act into law which would have provided health insurance to all residents by 1992. It had an employer mandate and provided Medicaid coverage to former welfare recipients. In 1995 through 1997 the state implemented its first 1115 waiver that extended health care and created additional cost efficiencies. At the same time the state renamed their Medicaid program MassHealth. The state also took major early efforts to provide personal care attendant services and home care options to seniors and people with disabilities through a variety of programs. In 2006 then governor Mitt Romney signed the Masssachusetts Healthcare Reform Bill which included an individual mandate, a state health insurance program, employer fair share contributions and an expansion of the Medicaid program. The latest focus of the MassHealth program has been on cost containment after the state after the passage of the cost containment strategy bill through delivery system reforms.
Medicaid Expansion Implementation: Massachusetts’s 2006 reforms were used as the blueprint for the national 2014 health coverage reforms. However, there were significant changes that required the state to make changes to their eligibility and enrollment systems. The state was not prepared for these changes at the time of the open enrollment period starting in October 2013 and requested a waiver to provide applicants with Medicaid fee-for-service coverage while their eligibility was being determined by the state.
General facts about Massachusetts Medicaid:
Medicaid program name: MassHealth
CHIP Program name: MassHealth
Separate or combined CHIP: Combination
Medicaid Enrollment: 1.6 million (2018 estimate)
Total Medicaid Spending: $17.3 billion (FY 2017 estimate)
Share of total population covered by Medicaid: 23% (estimate)
Share of Children covered by Medicaid: 33%
Share of Medicaid that is Children and Adults: 70% (estimate)
Share of Spending on Elderly and people with disabilities: 58% (estimate)
Share of Nursing Facility Residents covered by Medicaid: 66% (estimate)
Expansion state: Yes
Number of people in expansion: 398,300
Work Requirement: No