When you’re wondering/
About Medicaid/
Where you gonna look?
Resource Spotlight: KFF
With the onslaught of news erupting out of Washington on an hourly basis, there are more and more moments during which I crave data and evidence-supported analysis to understand what the healthcare landscape actually looks like and how policy proposals could impact people. I often turn to KFF.org for their research and reports on Medicaid, such as state fact sheets
and impacts on particular population groups (like seniors or children with special health care needs), as well as analysis on relevant topics like how potential cuts to Medicaid could affect state budgets.
KFF also has a newsroom, called KFF Health News, dedicated to reporting on complex health policy issues. In addition to articles and investigations available here, KFF Health News has a podcast called “What the Health,” featuring 30-minute-ish discussions on the latest health news.
Topics for this week’s Health Announce:
- Healthcare Workgroup meets this Wednesday.
- Presenting Being Heard: The Experience of Non-English Speakers with the MassHealth Call Center, by MLRI’s own Kate Symmonds.
- Update on Commonwealth Care Alliance.
- Proposed CMS Marketplace Rule.
- PCA Working Group G.L. 140 Report.
- Coming up: MLRI’s Elder Benefits Training.
Be well,
Jennifer Hotchkiss Kaplan
Senior Health Law Attorney
Massachusetts Law Reform Institute
1. Healthcare Workgroup meets this Wednesday.
This Wednesday, March 26, 2025, from 3pm to 4:30 pm, the Healthcare Work Group (HCWG) will meet. The agenda includes:
- CMS Notice of proposed rule – Marketplace
- CCA developments
- CommonHealth and MSP developments
- Immigrant MassHealth members’ concerns – e.g., address verification
If you have any additional topics or issues you’d like to put on the agenda, please let me (jkaplan@mlri.org) know.
2. Presenting – Being Heard: The Experience of Non-English Speakers with the MassHealth Call Center, by MLRI’s own Kate Symmonds.
Last week, MLRI released a report exploring the barriers that non-English speakers face when trying to communicate with MassHealth through its call center. The report draws on the experiences of MassHealth members who were delayed in getting the health care they needed because of language access barriers. While recognizing that MassHealth has made progress, the report finds that there remains significant room for improvement and provides specific recommendations to MassHealth to improve language access. Read the report here.
3. Update on Commonwealth Care Alliance.
Currently, thousands of elderly or disabled people are enrolled in the Commonwealth Care Alliance (CCA) plan through MassHealth’s Senior Care Options (15,000) or One Care program (31,000). In November 2024, MassHealth closed new enrollment into CCA because the plan’s reserves had fallen below required thresholds. A March 4, 2025 Globe story headlined “Insurer for nearly 50,000 poor, elderly, disabled people in Mass. running out of money” reported on its recent financial troubles and disability activists calling on the state to put CCA into receivership.
Last week, on March 18, 2025, Disability Advocates Advancing our Health Care Rights (DAAHR) hosted a forum attended by about 200 people and MassHealth officials to talk about the CCA situation. MassHealth members had universal praise for the two practices owned by CCA coupled with criticism of recent experiences with the CCA insurance plan. Participants
expressed serious concerns about continuity of care and continued access to care were CCA to leave the MassHealth program. The Disability Policy Consortium (DPC) and Health Law Advocates explained why they are urging the AGO to put CCA into receivership as the best way to protect beneficiaries and preserve the CCA model of care.
As reported in the Globe story on the forum headlined, “State prepares in case of collapse of Commonwealth Care Alliance, insurer for 50,000 poor, elderly, and disabled people” Kate Walsh, the Secretary of EOHHS, noted that the CCA-owned clinical practices will continue to participate in MassHealth, pointed out that more plans will be available in October in both One Care and SCO for coverage starting in Jan 2026, and described what steps the agency was taking to protect beneficiaries were CCA to end its One Care and SCO plans in 2025. Additionally, EOHHS posted a bid solicitation for qualified entities to provide continues access to care coordination and services for eligible members transitioning to MassHealth fee-for-service.
For more information from DPC about its call for a receiver and how to add your voice:
4. Proposed CMS Marketplace Rule.
The following section comes entirely from Marcella Lampon at Health Care for All:
On March 10th, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule called “Marketplace Integrity and Affordability” that addresses a variety of eligibility and enrollment processes and policies for Marketplaces like the Health Connector and the insurance markets in which they operate. The proposed rule would reverse several previous policies and put in new restrictions on eligibility, enrollment, and affordability. Comments are due April 11th. HCFA will be circulating a sign-on letter soon.
Key provisions of the proposed rule include:
Eligibility
- Elimination of eligibility for coverage for Deferred Action on Childhood Arrival (DACA) recipients in the Health Care Marketplaces
- Modifications to eligibility processes for verifying income that would require additional action by consumers and reduce time to provide documents
- Reduction in the amount of time individuals have to reconcile advance premium tax credit amounts before Marketplaces must deny further subsides from two years to one
Enrollment
- Standardization of Marketplace Open Enrollment periods to 11/1-12/15, with no option for State-Based Marketplaces (like the Health Connector) to extend beyond
- Increased pre-enrollment verification of qualifying life events to shop outside of Open Enrollment
- Elimination of a special enrollment period for individuals with income up to 150 percent of the Federal Poverty Level (FPL)
- Changes to the renewal process
Insurance markets
- Prohibition on gender-affirming care being considered an Essential Health Benefit (though plans could continue to provide and states may require issuers to cover)
- Changes to indexing methodology that would likely result in higher cost sharing limits and lower premium tax credit amounts
- Modification of actuarial values associated with metallic tiers to allow lower value plans in each tier
- Modifications to agent/broker oversight in Marketplaces
You can find a more in-depth summary on the proposed Marketplace rule from the Health Connector here.
5. PCA Working Group G.L. 140 Report.
Last year’s budget bill, Chapter 140 of the Acts of 2024 (line 4000-0601, signed into law by Governor Healey, directed the Executive Office of Health and Human Services to “convene a working group to review the scope of services and eligibility thresholds of the personal care attendant program” (PCA) and submit recommendations.
On March 7, 2025, after five meetings, the PCA Working Group released a presentation of three recommendations reached through the consensus of its members. MassHealth should:
- Enforce the overtime cap at 66 hours.
- Ensure fraudulent activity within the PCA program is addressed.
- Eliminate managing PCA paperwork and PCA administrative work for members using EVV.
The full report is available here. While the three recommendations could result in savings of $7.4 million, those savings represent only 0.46% of the PCA program budget. The workgroup agreed to continue to meet on a voluntary basis through June to try to identify further recommendations.
6. Coming up: MLRI’s Elder Benefits Training.
On April 17, 2025, from 9:30 am to 4:00 pm at the MCLE conference center, MLRI is chairing a training that covers the key public benefits programs to help older adults meet their basic needs, from cash benefit programs like SSI and Social Security Insurance benefits to health care programs like MassHealth. Faculty include experts from GBLS, SCCLS, CLA, DLC, and the Executive Office of Aging and Independence. Register here.
Ray Parker Jr. - Ghostbusters
