Sustaining MassHealth


By Al Norman

As snowy February came to a close, Governor Charlie Baker told the public that “We are going to make some significant changes with respect to how the MassHealth program works going forward, because 13 percent growth in the MassHealth program is not only not sustainable for health and human services organizations; it’s not sustainable for all the other stuff state government needs to be able to do.” MassHealth is health insurance for poor people. Most of us would agree that health care is a basic need — some would say it’s a right.

alnorman_headshotDuring this long recession, it’s no wonder that more people have turned to MassHealth for health care coverage. Our state likes to boast that nearly all our citizens have health care. There is a cost to that success. The great thing about MassHealth is that the state gets 50 percent of what we spend back from the federal government.

There are many state expenditures that attract no federal match — so MassHealth is a better investment than most. The other “stuff” that the Baker Administration wants to spend money on includes education, economic development, and energy programs. These are all good investments — but affordable health care is as important as anything else state government does.

The goal should be to make all services we provide as efficient and outcome oriented as possible. Mass Home Care recently released a report entitled The Long Term Services Challenge, which notes that Massachusetts could better coordinate its long term services — while at the same time reduce the overall cost of care. Instead of concentrating on doctors and hospitals, the Mass Home Care report focuses on “post acute care” that is often non-medical in nature — the care at home that keeps people out of emergency rooms and hospital beds.

Our care transitions coaches follow people after they leave the hospital to help them successfully remain at home. “Least restrictive” care is the goal of the MassHealth statute. Massachusetts spends more than $3.7 billion annually on long term support services. Most of it has been spent on institutional care. In 2011, the per capita use of nursing facilities in Massachusetts was 46 percent greater than the U.S. average.

But community-based services have cut nursing facility patient days by 34 percent compared to the year 2000, saving taxpayers as much as $853 million in 2015 alone. We can have a system that gives seniors the care they want, where they want it—at home — and have a “sustainable” MassHealth budget.

Better overall integration of health care and functional long-term supports will be cheaper, produce better outcomes, and increase patient engagement in their own care. MassHealth spending on nursing facilities was called a “budget buster” in the 1980s. We have tamed that beast.

Now we need to focus on “whole care,” which includes community care that takes place outside the walls of our hospitals, and beyond the confines of the doctor’s office.

Al Norman is the executive director of the Mass Home Care Association.