I. INTRODUCTION AND CONTEXT -

MassHealth, Massachusetts’ Medicaid program, is the largest payer of long-term services and supports (LTSS) in the Commonwealth and administers a number of LTSS programs, some in conjunction with other state agencies. Only 14 percent of MassHealth enrollees, or about 251,000 people, utilize LTSS, yet they account for over 30 percent of all MassHealth spending, or about $4.5 billion annually. Individuals who utilize LTSS span the population—nearly half are elderly, and a third are non-elderly adults and children with disabilities. They have diverse and complex care needs and often face serious issues finding safe, affordable housing and transportation to medical appointments and overcoming other social barriers to care.

Massachusetts and the nation as a whole are beginning to grapple with how to improve access to quality care for individuals who require LTSS while simultaneously containing costs. States are increasingly covering LTSS through managed care arrangements, and the new Medicaid managed care regulations released by the Centers for Medicare and Medicaid Services (CMS) acknowledge this shift by adding for the first time specific protections for beneficiaries in managed LTSS programs. In addition, states continue to shift care away from institutional settings and into home- and community-based settings, which individuals and their families vastly prefer. In fact, home- and community-based services (HCBS) now account for 70 percent of all MassHealth LTSS expenditures.