CMS Medicaid Waiver Allows Massachusetts to Expand Coverage to Incarcerated

MassHealth, the Massachusetts Children’s Health Insurance and Medicaid Program (CHIP), received federal approval to modify its Section 1115 Demonstration.

The 1115 Waiver, approved by the Centers for Medicare and Medicaid Services (CMS) through December 2027, allows Massachusetts to expand health insurance subsidies to people who would not otherwise be eligible for Medicaid or CHIP, offer services they would not normally are covered by Medicaid and use innovative service delivery systems that improve care, increase efficiency and reduce costs.

For example, MassHealth has been given 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 their release.

The amendment also provides federal funding to support the extension of Massachusetts Health Connector health insurance subsidies to more low- and middle-income Massachusetts residents, making health insurance more affordable.

CMS also authorized MassHealth to:
• Provide 12 months of continuous eligibility for adults and 24 months of continuous eligibility for homeless members who are 65 years of age or older. MassHealth has the authority to extend 12 months of continuous eligibility to all adults age 19 and older. Continued eligibility for children under age 19 began in January 2024, so this amendment would extend 12 months of continued eligibility to all MassHealth members. Continuous eligibility means that members will retain coverage for the designated period even if they experience changes in their circumstances that would otherwise affect eligibility. MassHealth will also extend 24 months of continuous eligibility for homeless members age 65 and older.

• 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 lodging (STPHH) as a permitted service for health-related social needs. The amendment allows MassHealth to cover up to six months of short-term lodging after hospitalization or before the procedure (also known as respite) as a health-related social needs service. Through this amendment, MassHealth seeks to ensure that homeless members are discharged from hospitals to a safe space and, in doing so, avoid further intensive medical interventions and reduce the overall cost of care.
Include temporary housing assistance for pregnant members and families as allowable services for health-related social needs. 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 Emergency Assistance Family Shelter Program.

• Increase spending authority for the health-related social needs integration fund. The current MassHealth Demonstration 1115 includes authority for $8 million in infrastructure investments for organizations that provide 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 standard MassHealth members to the state legal limit. The amendment expands the Medicare Savings Program by tying federal eligibility to the income limit set in state law. This would mean that more low-income people would qualify for assistance paying their Medicare premiums.

“This approval allows the Administration to directly build on our existing efforts to advance health equity and ensure Massachusetts residents are universally insured,” MassHealth Deputy Secretary Mike Levine said in a statement. “I look forward to partnering closely with providers, plans, members and CMS as we work to implement these important reforms.”

“The Department of Youth Services prioritizes the health of our youth as they transition into the community, and Waiver 1115 will further support DYS’ commitment by ensuring that essential transitional health services are covered up to 90 days before their release,” the DYS commissioner said. Cecely Reardon, in a statement: “This initiative exemplifies how collaboration between state agencies can drive positive change for our shared youth.”

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