Approved 1115 Waiver Amendment will Make Health Care More Accessible, Equitable and Affordable for Hundreds of Thousands of Residents

Boston, MA - The Healey-Driscoll Administration announced April 19, 2024 that it received federal approval for MassHealth, Massachusetts’ Medicaid and Children’s Health Insurance Program (CHIP), to amend its Section 1115 Demonstration (“1115 waiver”). The new federal authority will make health care more accessible, equitable, and affordable for hundreds of thousands of Massachusetts residents.

The 1115 waiver, approved by the Centers for Medicare and Medicaid Services (CMS) through December 2027, supports continued progress toward comprehensive, equitable health care for the agency’s more than 2 million members, with a focus on expanding coverage and addressing health-related social needs. It provides federal authority for Massachusetts to expand health insurance subsidies to individuals who are not otherwise Medicaid or CHIP eligible, offer services that are not typically covered by Medicaid, and use innovative service delivery systems that improve care, increase efficiency, and reduce costs. 

MassHealth has received federal authority to cover a wide range of health services for eligible incarcerated individuals, including youth in Department of Youth Services (DYS) facilities, up to 90 days prior to release. The amendment also provides federal funding to support the Massachusetts Health Connector’s extension of health insurance subsidies to more low- and middle-income Massachusetts residents, making health insurance more affordable and advancing the Healey-Driscoll Administration’s goal of universal coverage.

“Massachusetts has the greatest health care system in the country, but we need to make sure all of our residents can afford it and access it. This latest waiver amendment will expand access to high-quality, affordable health care for hundreds thousands of people who need it most,” said Governor Maura Healey.“We’re grateful to the Biden-Harris administration for this approval, and I congratulate our team led by Secretary Kate Walsh and Assistant Secretary Mike Levine for their hard work to deliver this win for Massachusetts.”

“We are extremely pleased with this approval and grateful to CMS for their support,” said Lieutenant Governor Kim Driscoll. “This extension reinforces our ability to provide equitable care for all residents, including the most vulnerable populations in Massachusetts.” 

"This waiver is a statement of values - access, dignity, compassion. People in Massachusetts should never have to question whether they will have the care, support, and services they need to protect their health, and this waiver moves us closer to that reality,” said Senator Ed Markey. “I am proud to work with the Biden-Harris administration, Governor Healey and the Congressional delegation in support of our shared commitment for a healthier, and more just and equitable Commonwealth.”

“Every person should be able to get the health care they need when they need it, but medical bills can stretch a family's budget to the breaking point,” said Senator Elizabeth Warren. “I’ve been working for months behind-the-scenes and in partnership with the Healey-Driscoll administration to deliver this much-needed federal action, which will bolster our health care system and lower costs for more people in Massachusetts.”

Through the newly approved amendment, CMS authorized MassHealth to: 

- Provide pre-release MassHealth services to individuals in certain public institutions.   

- Expand marketplace (Health Connector) subsidies to additional individuals.  

- Provide 12 months of continuous eligibility for adults and 24 months of continuous eligibility for members experiencing homelessness who are 65 and over.  

- MassHealth has the authority to extend 12 months of continuous eligibility to all adults aged 19 and over. Continuous eligibility for children under age 19 began in January of 2024, so this amendment would extend 12 months of continuous eligibility to all MassHealth members. Continuous eligibility means that members will retain coverage for the appointed period even if they experience changes in their circumstances that would otherwise affect eligibility.  

- MassHealth will also extend 24 months of continuous eligibility for members experiencing homelessness age 65 and over. 

- Implement three months of retroactive eligibility.

- MassHealth will implement three months of retroactive coverage from the day of application for all members.   

- Include short-term post hospitalization housing (STPHH) as an allowable health related social needs service.

- The amendment permits MassHealth to cover up to six months of short-term post-hospitalization/pre-procedure housing (also known as medical respite) as a heath related social needs service.  

- Through this amendment, MassHealth seeks to ensure that members experiencing homelessness are discharged from hospitals to a safe space and, by doing so, avert further intensive medical interventions and reduce the total cost of care. 

- Include temporary housing assistance for pregnant members and families as allowable health related social needs services.

- This amendment authorizes temporary housing assistance and supportive services for clinically eligible families and pregnant individuals who are enrolled in comprehensive MassHealth coverage and who are receiving services through the Commonwealth’s Emergency Assistance Family Shelter Program.  

- Increase the expenditure authority for the health-related social needs integration fund. 

- MassHealth’s current 1115 Demonstration includes authority for $8 million in infrastructure investments for organizations providing health related social needs services to MassHealth members.  

- This expanded authority allows MassHealth to claim up to an additional $17 million in funding, for a total amount of $25 million for infrastructure investments. 

- Increase the income limit for Medicare Savings Program Benefits for members on MassHealth standard to the state statutory limit.

- The amendment extends the Medicare Savings Program by tying federal eligibility to the income limit in state law. This would mean that more low-income individuals would qualify for assistance in paying for their Medicare premiums.

“Massachusetts is committed to delivering high-quality and equitable care for Massachusetts residents,”said Secretary of Health and Human Services Kate Walsh.“The approval of this waiver allows for greater access to the care residents need. I am grateful to CMS, the MassHealth team, and our partners for their work to improve health outcomes for members.”  

"This approval allows the Administration to build directly upon our existing efforts to advance health equity and ensure Massachusetts residents are 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 implement these important reforms.”

“The 1115 Demonstration amendment reinforces our commitment to delivering affordable health coverage to everyone who needs it, including through the Marketplace,” said Executive Director of the Massachusetts Health Connector Audrey Morse Gasteier. “Our success in Massachusetts is built on a strong partnership between the Commonwealth and the federal government, and we look forward to continue to build on that success together.”

"The Department of Youth Services prioritizes the health of our young people as they transition into the community, and the 1115 Waiver will further support DYS’ commitment by ensuring essential transitional health services are covered up to 90 days prior to release,” said DYS Commissioner Cecely Reardon. “This initiative exemplifies how collaboration among state agencies can drive forward positive change for our shared young people.”

"In authorizing pre-release services to incarcerated individuals who are reentering the community through the 1115 Demonstration, we are taking a significant step towards a commitment the Sheriffs have made in improving health outcomes for qualified individuals in their care and custody," said President of the Massachusetts Sheriffs' Association Sheriff Nicholas Cocchi. "The extension of pre-release MassHealth services will enhance the well-being and future of those incarcerated by facilitating continuity of care and establishing trust for individuals 90 days prior to release. Through this collaborative partnership, we are continuing to pave the way for a more inclusive, effective, and compassionate approach to the criminal justice system."

Further information is available online: 

- The October 16, 2023 1115 waiver demonstration request can be found at:1115 MassHealth Demonstration ("Waiver") | Mass.gov