The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), approved groundbreaking Medicaid section 1115 demonstration initiatives in Massachusetts and Oregon. Both demonstrations aim to test improvements in coverage, access, and quality with innovative approaches to ensure more eligible people retain their Medicaid coverage, including by approving Oregon’s demonstration to keep children enrolled in Medicaid up to age six — preventing gaps in coverage that can cause children to lose access to needed care in their formative early years.
The initiatives also take steps to address unmet health-related social needs, such as by giving Massachusetts and Oregon new authority to test coverage for evidenced-based nutritional assistance and medically tailored meals, clinically-tailored housing supports, and other interventions for certain beneficiaries where there is a clinical need. These efforts coincide with the White House Conference on Hunger, Nutrition, and Health, where the Biden-Harris Administration released its national strategy to end hunger, improve nutrition and physical activity, and reduce diet-related diseases and disparities – all goals supported by the initiatives approved today.
“This is an historic moment in our nation’s fight to end hunger and improve health equity, particularly in states like Oregon and Massachusetts,” said HHS Secretary Xavier Becerra. “Groundbreaking action in each state will ensure children and youth remain connected to health care, and that we double down on tackling social needs impacting health, such as nutrition. Everyone should get the access to care they need to live safe and healthy lives.”
“I’m proud to partner with Oregon and Massachusetts to improve quality and access, reduce health disparities, and improve health equity, for those who need it most. For the first time ever, children with Medicaid coverage in Oregon will be able to keep their coverage until the age of 6 — ensuring they can get the care they need during their formative years. This is just one aspect of the groundbreaking demonstration initiatives that I’m approving today,” said CMS Administrator Chiquita Brooks-LaSure. “These states are also partnering with community-based providers to address the root social causes of health concerns, like lack of access to nutritious food and housing insecurity. We applaud Massachusetts and Oregon for helping us use every tool available to protect and expand access to high-quality, comprehensive, affordable health care coverage.”
Under the Biden-Harris Administration, thanks to the American Rescue Plan and other Administration efforts, more Americans than ever before have health insurance coverage. Today’s approvals will build on these efforts and support President Biden’s executive orders in April 2022 and January 2021 directing federal agencies to take action to expand affordable, quality health coverage, including by strengthening Medicaid and the Affordable Care Act.
Both demonstrations approved today will work to improve enrollment and continuity of coverage. In Oregon, children determined eligible for Medicaid will be able to stay continuously enrolled until they turn six years old, without their families needing to renew their coverage. This will minimize red tape for both families and the state, and help to ensure access to care throughout this critical period of early childhood. Individuals older than six will be able to keep their coverage for up to two years, even if their household income fluctuates. Massachusetts will provide up to 12 months of continuous coverage for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries upon release from correctional settings and 24-months of continuous eligibility for beneficiaries with a confirmed status of chronic homelessness, eliminating gaps in coverage for these vulnerable populations.
Evidence indicates that health-related social needs, such as food insecurity and housing instability, are critical drivers of an individual’s health outcomes. With this demonstration, Massachusetts will receive expanded authority to provide certain time-limited housing supports, clinical nutrition education, and medically-tailored food assistance services when medically appropriate. These services will be available to a range of at-risk populations, including postpartum individuals for up to 12 months. Massachusetts will also provide additional meal support for certain households when an eligible beneficiary is a child or pregnant woman with special clinical needs. Oregon will expand health-related social needs coverage for certain food assistance, housing supports, and other interventions that are medically appropriate for individuals experiencing certain life transitions, including individuals who are homeless or at risk of homelessness. In both states, the time-limited housing and nutritional support services provided in the demonstration can be expected to stabilize the housing and nutritional circumstances of these Medicaid enrollees and thus ensure that they will keep receiving and benefiting from the Medicaid-covered services to which they are entitled.
Massachusetts will also be implementing an innovative Hospital Quality and Equity Initiative for private acute hospitals and the Commonwealth’s only non-state-owned public hospital, Cambridge Health Alliance. The initiative is expected to reduce health inequities by improving outcomes in populations that are likely to face barriers to quality health care. As such, the demonstration is likely to help improve the quality of care and is also likely to reduce health disparities through this value-based care approach.
CMS will require both states to systematically monitor the demonstrations and conduct rigorous independent evaluations to determine the outcomes and impacts.