The Mass. Medicaid Program Is Changing How It Delivers Health Care

It's being called the biggest redesign of the Massachusetts Medicaid program in over two decades.

Starting Thursday, more than 800,000 state residents whose health insurance is provided by the program — MassHealth — find themselves under new insurance plans with new rules.

The state is moving most of its MassHealth patients to what are called accountable care organizations — networks of hospitals, doctors and other medical organizations that will now coordinate all of a patient’s care.

"This is part of a big national movement that was strongly pushed by the Obama administration to move from a system where providers are paid not for how much they did, but for how well they take care of you," John McDonough, former director of the consumer advocacy group Health Care For All, told Radio Boston Wednesday.

The changes are expected to save the state money, though officials have not estimated exactly how much.

The restructuring of MassHealth has been planned for years.

Marylou Sudders, the state’s health and human services secretary, says the goal is to eliminate confusion among different providers who may care for a patient.

"If we manage care well, we may reduce costs," she told WBUR. "Bbut this is not a cost exercise. This is really about ensuring the best health for our MassHealth members."

MassHealth members are automatically enrolled in one of 17 ACOs based on their primary care provider, and will be able to change their plan for any reason for 90 days.

Members who opt out of the ACOs can instead choose to enroll in one of two managed care organizations, which together will cover between 150,000 and 200,000 members, or MassHealth's primary care clinician plan, also expected to cover between 150,000 and 200,000 members.

The state has launched an informational website to help MassHealth recipients understand the changes.

With reporting by WBUR's Alison Bruzek and State House News Service

This article was originally published on March 01, 2018.


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