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Last week

It's been an eventful week. For those of you interested in the future of the Affordable Care Act, this blog post lays out some of the possibilities.
http://www.healthaffairs.org/blog/2016/11/09/day-one-and-beyond-what-trumps-election-means-for-the-aca/

In Massachusetts over 300,000 adults are enrolled in MassHealth and an additional 180,000 in Connector Care under provisions of the ACA.

If the Medicaid expansion and federal tax credits and subsidies in the ACA are repealed, it won't happen overnight. We still have the bones of our 2006 state health reform law on the books, but prior to the ACA we insured far fewer people at a far greater net state cost. Retaining coverage will require all hands on deck.

Meanwhile last Friday, MassHealth received approval from CMS (the federal Medicaid agency) for amendment and extension of its 1115 demonstration (the waiver) to 2022. Approval allows MassHealth to move ahead with plans for Accountable Care Organizations that will change the way providers are organized and paid. The goals are to reduce state spending and provide more coordinated care. Approval also secures billions in additional federal funds over 5 years.

It's far too early to speculate how a new federal administration may affect the waiver. However, approval does not insulate MassHealth from future changes in federal law or policy or a new administration taking a different view of whether the waiver serves the public interest.

MassHealth has posted the waiver documents as well as a press release, summary and FAQs here:

http://www.mass.gov/eohhs/gov/departments/masshealth/1115-waiver-proposal-information.html

Much more to come on how the new waiver may affect MassHealth members and the need for advocacy on many important implementation issues going forward.