MassHealth

The MassHealth section 1115(a) Demonstration is designed to use a managed care delivery system to create efficiencies in the Medicaid program and enable the extension of coverage to certain individuals who would otherwise be without health insurance. The initial MassHealth demonstration was approved in 1995 to enroll most Medicaid recipients into managed care organizations (Medicaid managed care program). Unique features of the Demonstration include the Insurance Partnership (IP) Program and the Safety Net Care Pool. The IP program is an employer sponsored insurance (ESI) program, which provides a subsidy for employers with 50 or fewer employees as long as the employer contributes at least 50 percent of the total premium for the employee and any dependents. In addition to managed care savings, funds formerly used to make payment adjustments to disproportionate share hospitals (DSH) also are used to provide health care coverage. On April 12, 2006, the State adopted legislation designed to provide access to affordable health insurance coverage to all Massachusetts residents. The legislation, Chapter 58 of the Acts of 2006, titled An Act Providing Access to Affordable, Quality, Accountable Health Care (Act), builds upon the MassHealth section 1115 demonstration extension approved by CMS on January 26, 2005, which established the Safety Net Care Pool (SNCP). The Act accomplishes several goals of the negotiated demonstration extension including: improving the fiscal integrity of the MassHealth program, directing more federal and state health dollars to individuals and less to institutions, and subsidizing the purchase of private insurance for low-income individuals to reduce the number of uninsured in the Commonwealth.