Health Announce: July 17, 2025

07/17/25

Topics for this week's Health Announce:

  1. MassHealth updates regarding long-planned eligibility restrictions
  2. Proposed MassHealth regulations
  3. State officials’ comments on the impact of the federal reconciliation bill
  4. Congrats to the new EOHHS secretary: Dr. Kiame Mahaniah
  5. HCWG on July 23 at 3pm
  6. Health and Human Services notice redefining “federal public benefits”

MassHealth updates regarding long-planned eligibility restrictions (not related to federal reconciliation act)

With the release of the Healey Administration’s proposed FY26 budget in January (the final budget was signed by the Governor on July 4), MassHealth announced a number of planned initiatives to either expand access or cut costs. Unfortunately, MassHealth is moving forward with the changes that would limit eligibility, and deferring the changes that would expand access, pointing to the federal reconciliation act’s new requirements which the state must implement in short time frames as well as uncertain federal revenue. Some of the deferred positive changes include increasing the asset limit, reducing the spenddown for applicants of HCBS waivers and PACE, and excluding from countable assets up to $10k of the value of whole life insurance. Below is a list of changes that would limit access and eligibility, which MassHealth plans to implement over the next year:

Five year look-back period for HCBS waivers and PACE

  • What: MassHealth plans to implement a 5 year look-back period for applicants of Home and Community Based Services (HCBS) and the Program of All Inclusive Care for the Elderly (PACE). Like the 5 year look-back period applied to nursing home residents, this look back period would require applicants to show that they did not transfer assets for the purpose of qualifying for MassHealth during the five year period before applying to a HCBS waiver or PACE.
  • When: starting for new applicants in the spring of 2026

Counting spousal assets for PACE applicants

  • What: Currently, the spousal assets of PACE applicants are not counted towards the applicants’ eligibility. MassHealth plans to change this, applying to PACE the same rule about the treatment of spousal assets that now applies to nursing home residents and to the HCBS waiver programs.
  • When: starting for new applicants in the late fall of 2025

Increasing premiums by 10% and indexing for inflation

  • What: Most MassHealth members do not pay premiums, but children in Family Assistance and members of CommonHealth with income over 150% FPL do. MassHealth has not changed its premium formulas for the past 10 years. MassHealth plans to increase premiums by 10% across the board, and index premiums to inflation. MassHealth expects an average increase of about $5 to $10 per month for members.
  • When: December, 2025.
  • In a related development, MassHealth has proposed changes to its premium rules at 130 CMR 506 that would delete the tables that now describe the premiums for children from 150-300% FPL and the formulas used to calculate premiums for adults with income over 150% FPL and for children over 300% FPL. Instead, the proposed rules state that MassHealth will publish premium amounts on an annual basis starting in 2026. The proposed rules do not explain how the base rate for premiums will be calculated or how they will be indexed for inflation. A public hearing on these and other changes to premiums and premium assistance is scheduled for July 25, 2025.

2. Proposed MassHealth Regulations

Last week we described two sets of proposed MassHealth regulations: one set affecting premiums and premium assistance with a public hearing on July 25 (discussed above) and the other set affecting coverage and eligibility for people under 65 with no public hearing but a comment period until July 25, 2025. We are still analyzing the proposed rule changes and will discuss them at the July 23 Health Care Working Group meeting.

3. State officials’ comments on the impact of the federal reconciliation bill

As we all know by now, the Republicans’ reconciliation bill was signed into law on July 4, trading health care for millions for tax breaks for billionaires. On July 10, the Globe published an article, Mass. officials prepare for major Medicaid cuts after new requirements signed into law by Trump, citing Mike Levine (Assistant Secretary for MassHealth) and Audrey Gasteier (Executive Director of the Massachusetts Health Connector) as saying that 200,000 people on MassHealth and 100,000 on insurance through the Health Connector are at risk of losing coverage as a result of changes made by the reconciliation act.

At the time the Globe article was published, the state did not have an estimate of potential financial losses. But since, MassHealth told advocates that the state expects to lose $3.5B in federal funding per year (due to changes to both the MassHealth and the Health Connector) once all the reconciliation act's changes are implemented by 2029.

The National Health Law Project (NHelp) has produced a Table showing the effective dates of various health related provisions of the reconciliation act.

4. Congrats to the new EOHHS secretary: Dr. Kiame Mahaniah

On July 11, 2025, Governor Healy announced that she was appointing Dr. Kiame Mahaniah to replace outgoing EOHHS Secretary Kate Walsh. Dr. Mahaniah had been Undersecretary for Health at EOHHS since 2023 and was previously the CEO of the Lynn Community Health Center. Congratulations to Dr. Mahaniah on his appointment. He takes the reins at a challenging time for MassHealth but has the experience and values to rise to the challenge. Kate Walsh will stay on for a time as senior advisor to the Governor, and we thank her for her leadership during her tenure which included salvaging 5 hospitals from the implosion of the Steward health care system.

5. Health Care Working Group meeting on July 23 at 3pm

Our next Health Care Working Group meeting will be next Wednesday, July 23, at 3pm. Please email Jkaplan@mlri.org or ksymmonds@mlri.org if you would like to add anything to the agenda.

6. Health and Human Services notice redefining “federal public benefits”

The US Dept of Health & Human Services issued a July 14, 2025 Notice adding the names of 13 federal programs including the Health Center Program, Head Start, and many Mental Health and Substance User Disorder programs to the list of “federal public benefits” as defined in a 1996 welfare reform law that will now be limited to “Qualified Aliens.” The term “Qualified Alien” excludes many categories of lawfully present immigrants such as people with TPS, asylum applicants, special immigrant juvenile and many more.

HHS is fundamentally changing its 1998 interpretation of a 1996 law because HHS says it has been wrong for the last 27 years. In doing so, it raises many legal issues, and leaves many complicated implementation questions unanswered for the mostly nonprofit charitable organizations administering these programs. Two things are clear, the Trump administration is intent on scapegoating immigrants and adding a citizenship and immigration status requirement to programs that never had one before means it will be costlier to administer the programs and harder for everyone seeking services to get them.

While HHS is not waiting for comments to change its interpretation, the July 14 Notice is open for public comment until August 13, 2025.

The press release on July 10, 2025 states HHS will issue further notice to affected programs.

This is part of the July 11, 2025 statement from the League of Community Health Centers:
“By mission and by mandate, community health centers have been required by law to care for all people who come through their doors, throughout their sixty-year history. …
While we work to fully understand this new rule and await further guidance from the administration, we will continue to support our patients.
We are gravely concerned with any policy that discourages patients from seeking critical health care services, at the expense of their wellbeing, as well as the public’s health."

More to come as we learn more!