Feds approve MassHealth restructure, deny Medicaid work requirements in New Hampshire

Medicaid on paper and a stethoscope

Photo credit: Getty/designer491

Two neighboring New England states received different Medicaid waiver judgments, highlighting the nuanced approach by federal health authorities tasked with approving state proposals.

The Centers for Medicare & Medicaid Services (CMS) approved a five-year waiver allowing Massachusetts to overhaul its Medicaid program known as MassHealth, according to an announcement from Gov. Charlie Baker. The waiver, which authorizes more than $52.4 billion to the program, allows the state to use accountable care organizations (ACOs) to transition toward value-based payments and bolster coordinated care efforts.

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The MassHealth waiver includes targeted efforts to improve behavioral health services, substance abuse treatment and social services such as housing stabilization. The funding will also expand the state’s residential rehab programs in an effort to combat opioid addiction.

The state’s top health officials told The Boston Globe that the new ACO arrangement will help control MassHealth costs that have consumed nearly 40 percent of the state’s budget.

Just next door, however, CMS denied New Hampshire’s waiver request to implement a work requirement and impose stricter identification requirements for Medicaid beneficiaries, according to the Union Leader. But the denial did not kill the state’s expanded program altogether, thanks to a legislative clause that allowed New Hampshire to maintain Medicaid expansion to 50,000 residents regardless of the decision from federal authorities.

New Hampshire lawmakers admitted the work and ID requirements were unlikely to pass federal scrutiny, particularly since CMS had already rejected similar waiver requests in Ohio and Arizona.

Elsewhere, Centene finalized a settlement with Kentucky over a longstanding legal battle that ensued after the insurer broke its managed care contract and sued the state in 2012 over hefty financial losses. After the state countersued and a court ruled the contract couldn’t be terminated, Centene subsidiary Kentucky Spirit Health Plan Inc. will receive an “immaterial cash payment” and all parties will dismiss their claims.

Meanwhile, Centene announced its Nevada subsidiary, Silver Summit Health Plan, had been selected to serve select beneficiaries enrolled in the state's Medicaid managed care program.