Massachusetts’ proposed Medicaid reforms — cheaper drugs and better coverage?

New England Journal of Medicine

13 December 2017 - While health policy attention in recent months has focused on Washington, D.C., several proposals from individual states have garnered less publicity despite their potentially far-reaching implications. 

One such proposal comes from Massachusetts, which has applied for a waiver from federal rules in order to shift 140,000 near-poor adults — those with incomes between 100% and 138% of the federal poverty level — from Medicaid into private plans on the state’s health insurance marketplace and, perhaps more important, to create a closed drug formulary for Medicaid, which would be a first for the program. 

The administration of Massachusetts Governor Charlie Baker — a Republican who has opposed national efforts to repeal the ACA — argues that these changes are needed to manage the state’s Medicaid budget and to “improve care, reduce costs, and achieve administrative efficiencies.”

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Michael Wonder

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Michael Wonder