CMS approves $52 billion waiver for Massachusetts to overhaul Medicaid

The CMS has approved a waiver that will allow Massachusetts to overhaul its Medicaid program by putting its beneficiaries into accountable care organizations. Starting in July, the state will move its entire Medicaid population into an ACO. The state's current system is roughly half fee-for-service and half managed care. The waiver authorizes $52.4 billion over five years and generates $29.2 billion of federal revenue for the state. “This waiver is the first major overhaul of the MassHealth program in 20 years and includes critical reforms to promote coordinated care, hold providers accountable and offer expanded access for substance abuse disorder services,” Republican Gov. Charlie Baker said in a statement. Members will be placed in one of three ACOs based on which one their primary doctor chooses. Each primary-care provider can participate in only one ACO model and each model carries varying levels of risk. The waiver also allows the state to use federal funds to expand residential rehabilitation service programs and fund care-coordination and recovery services for beneficiaries with substance abuse disorders. The waiver continues to funnel federal funds into the state's hospital pool for uninsured individuals. The CMS had increasingly questioned the need of such pools following Medicaid expansion under the Affordable Care Act. Over the next five years, Massachusetts will receive $4.8 billion to pay for uncompensated care by safety net providers.

—Virgil Dickson

NYC Health & Hospitals President and CEO Dr. Ram Raju is leaving the municipal health system effective Nov. 30. Stanley Brezenoff, a former head of the public health system will take over as interim chief executive. Raju did not say why he was leaving or whether he was taking a job elsewhere. A spokesman for Health & Hospitals said Raju was not retiring. “He is keeping his professional options open,” the spokesman said. The system is facing a potential $1.8 billion budget gap by fiscal 2020, and plans presented by Raju and Mayor Bill de Blasio to address the system's troubles have been criticized for not going far enough. De Blasio said he does not want to lay off employees or reduce medical services. The city helped plug the system's budget gap with a $337 million bailout in January followed by another $160 million infusion in April. Raju spent 2½ years atop the nation's largest public health system trying to address the financial difficulties of the city's safety-net provider. He proposed a plan in April 2015 to stabilize the system's finances by 2020. The plan called for doubling membership in the city's MetroPlus health insurance plan to 1 million and increasing the number of city residents treated by the system annually to 2 million, from 1.4 million. “I step down feeling certain that the work we have accomplished over the last 2½ years puts us on solid ground to build a stronger, more efficient and financially sustainable public health care system,” Raju said in a statement. Brezenoff has years of experience in both the public and private health sectors. He served as president of the city's health system, formerly the New York City Health and Hospitals Corp., from 1981 to 1984, and later was first deputy mayor under Mayor Ed Koch. In 2003, he took over as CEO of Continuum Health Partners, which included Beth Israel Medical Center and St. Luke's Roosevelt-Hospital, from 2003 to 2013. Continuum was acquired by Mount Sinai Hospital in 2013.

—Jonathan LaMantia and Erica Teichert