"One Eye on Washington" by Robert Seifert

MassHealth, the Massachusetts Medicaid program, has already contributed strongly to the goals of health reform: increasing enrollment by 40,000 as of the end of January (of an estimated 89,000 made newly eligible by Chapter 58), and providing systems operations support to the Connector in order to get Commonwealth Care up and running. (MassHealth enrollment actually dipped – probably temporarily – in January, the result of the resumption of an administrative requirement to periodically re-establish eligibility that had been suspended since last July.)

MassHealth provides a foundation for health reform in other important ways that warrant policy makers’ attention.

The source of the Commonwealth Care premium subsidies is a combination of state and federal Medicaid funds made available through the MassHealth research and demonstration waiver, a 10-year-old agreement between state and federal Medicaid officials under which the MassHealth program is operated. The waiver expires at the end of June 2008 and must be renewed; what promises to be a challenging negotiation between the Patrick Administration and federal authorities will begin later this year. (A section of this new report explains some of the issues.)

MassHealth will also be affected by the outcome of the debate between Congress and the Bush Administration regarding the reauthorization of the State Children’s Health Insurance Program (“SCHIP”) in next year's federal budget. The Massachusetts SCHIP program is integrated with MassHealth; it allows expanded eligibility and brings federal dollars into the state that are not subject to the constraints of the Medicaid waiver. An unfavorable resolution of the SCHIP debate from the State's perspective could potentially affect health reform both directly, if eligibility must be pared back, and indirectly, by putting pressure on the waiver's “budget neutrality” formula that determines how much federal Medicaid money comes to Massachusetts.

The success of health reform depends mostly, but not entirely, on actions and decisions within the control of people right here in Massachusetts. The larger context of Medicaid and SCHIP, and the role the federal government plays in those programs, mean we must be concerned with policy decisions made beyond the State’s borders as well.

Robert Seifert is Executive Director of the Massachusetts Medicaid Policy Institute