CMS Medicaid Waiver Allows Massachusetts to Expand Coverage to Incarcerated

MassHealth, Massachusetts’ Medicaid and Children’s Health Insurance Program (CHIP), has received federal approval to amend its Section 1115 Demonstration. 

The 1115 waiver, approved by the Centers for Medicare and Medicaid Services (CMS) through December 2027, allows Massachusetts to expand health insurance subsidies to individuals who are not otherwise eligible for Medicaid or CHIP, offer services that are not typically covered by Medicaid, and use innovative service delivery systems that improve care, increase efficiency, and reduce costs.  

For instance, MassHealth has received federal authority to cover a wide range of health services for eligible incarcerated individuals, including youth in Department of Youth Services (DYS) facilities, up to 90 days prior to release. 

The amendment also provides federal funding to support the Massachusetts Health Connector’s extension of health insurance subsidies to more low- and middle-income Massachusetts residents, making health insurance more affordable. 

CMS also authorized MassHealth to:  
• Provide 12 months of continuous eligibility for adults and 24 months of continuous eligibility for members experiencing homelessness who are 65 and over. MassHealth has the authority to extend 12 months of continuous eligibility to all adults aged 19 and over. Continuous eligibility for children under age 19 began in January of 2024, so this amendment would extend 12 months of continuous eligibility to all MassHealth members. Continuous eligibility means that members will retain coverage for the appointed period even if they experience changes in their circumstances that would otherwise affect eligibility.  MassHealth will also extend 24 months of continuous eligibility for members experiencing homelessness age 65 and over.  

• Implement three months of retroactive eligibility. MassHealth will implement three months of retroactive coverage from the day of application for all members.    

• Include short-term post-hospitalization housing (STPHH) as an allowable health-related social needs service. The amendment permits MassHealth to cover up to six months of short-term post-hospitalization/pre-procedure housing (also known as medical respite) as a heath-related social needs service.  Through this amendment, MassHealth seeks to ensure that members experiencing homelessness are discharged from hospitals to a safe space and, by doing so, avert further intensive medical interventions and reduce the total cost of care.  

Include temporary housing assistance for pregnant members and families as allowable health-related social needs services. This amendment authorizes temporary housing assistance and supportive services for clinically eligible families and pregnant individuals who are enrolled in comprehensive MassHealth coverage and who are receiving services through the Commonwealth’s Emergency Assistance Family Shelter Program.   


• Increase the expenditure authority for the health-related social needs integration fund. MassHealth’s current 1115 Demonstration includes authority for $8 million in infrastructure investments for organizations providing health-related social needs services to MassHealth members. This expanded authority allows MassHealth to claim up to an additional $17 million in funding, for a total amount of $25 million for infrastructure investments.  


• Increase the income limit for Medicare Savings Program Benefits for members on MassHealth standard to the state statutory limit. The amendment extends the Medicare Savings Program by tying federal eligibility to the income limit in state law. This would mean that more low-income individuals would qualify for assistance in paying for their Medicare premiums. 


"This approval allows the Administration to build directly upon our existing efforts to advance health equity and ensure Massachusetts residents are universally insured,” said Assistant Secretary for MassHealth Mike Levine, in a statement. “I look forward to partnering closely with providers, plans, members, and CMS as we work to implement these important reforms.” 

"The Department of Youth Services prioritizes the health of our young people as they transition into the community, and the 1115 Waiver will further support DYS’ commitment by ensuring essential transitional health services are covered up to 90 days prior to release,” said DYS Commissioner Cecely Reardon, in a statement. “This initiative exemplifies how collaboration among state agencies can drive forward positive change for our shared young people.”