Medicaid program name: MassHealth

Medicaid ACO program name: MassHealth ACO Program

Status: Active

Following an ACO Pilot program that operated six ACOs between 2016-2018, Massachusetts began a statewide ACO program in 2018 to serve its Medicaid beneficiaries. There are currently two health plan options under the MassHealth ACO program: Accountable Care Partnership Plans and Primary Care Accountable Care Organization Plans. Under the Accountable Care Partnership Plan, the ACO contracts with a managed care organization (MCO) to create a full network of care that includes primary care, specialists, behavioral health, and hospitals. Under the Primary Care Plan, groups of primary care providers coordinate the full range of services for beneficiaries by working with a network of specialists and hospitals and contracting with the Massachusetts Behavioral Health Partnership to provide behavioral health services. The MassHealth ACO program also began to pay for health-related nutrition and housing supports beginning in 2020, referred to as Flexible Services. As of 2022, MassHealth ACOs cover over 80 percent of eligible enrollees.

Many of the ACO provider organizations involved with the Medicaid program are also Medicare ACOs and many also serve privately insured patients. This effort is part of a comprehensive restructuring of MassHealth through ACOs with shared savings and mandatory but limited downside risk. The effort was initially funded by a 5-year, $1.8 billion Massachusetts 1115 Delivery System Reform Incentive Payment (DSRIP) waiver, which covered 2017-2022. In September 2022, CMS approved the state’s proposal to expand and extend the demonstration waiver through December 2027. This extension of the demonstration waiver will include improvements to the ACO and Community Partners programs, primary care capitation within ACOs, health equity incentive payments for ACOs and hospitals to reduce disparities, an increased focus on pediatric care coordination for children with complex needs, and additional support for safety net providers. Massachusetts views this as a major state-wide activity to help drive delivery system reform in private sector health care as well as Medicaid and Medicare. The initiative includes a substantial evaluation of the effects of the program.

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