New Study on Massachusetts Health Care Reform


The Robert Wood Johnson Foundation and the Urban Institute released a study on November 11 highlighting the contributions of outreach, enrollment, and information technology toward achieving 97.4 percent health insurance coverage in Massachusetts. Many other lessons learned from Massachusetts are already evident in various sections of the U.S. House and Senate health reform bills, but the new study focuses on key innovations and exemplary practices that are "secrets of the Massachusetts success":

  • A convenient, uniform application was developed for MassHealth (Medicaid), CommCare (a new program for previously uninsured adults with incomes up to 300 percent of the Federal poverty level), and other subsidized health programs;
  • Community-based organizations and providers were trained and offered grants and incentives to help consumers complete the uniform application on a secure website and to compile supporting documentation as needed;
  • An integrated IT system efficiently processed eligibility and enrollment transactions across multiple subsidized health programs;
  • Data from Massachusetts' earlier uncompensated care pool (UCP) program were accessed where appropriate to enroll many individuals in new programs automatically.

The study suggests that, with or without federal health care reform legislation, exemplary practices pioneered in Massachusetts will be crucial for other states attempting to achieve broader coverage:

  • Eligibility for subsidies/tax credits should be determined based on data already available (e.g., while not all states have pre-existing UCP programs exactly like Massachusetts, 86.3 percent of the uninsured currently file Federal income tax returns entered into Federal IRS data systems that states could access under revised income eligibility verification system (IEVS) agreements between IRS and the states);
  • Eligibility for all health benefits should be determined through integrated eligibility systems driven by user-friendly, uniform application formats;
  • Community-based organizations and providers should be offered appropriate training and incentives for outreach and assistance to uninsured persons.



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