Moving to the Vanguard on Pediatric Care: Recommendations for the MassHealth 1115 Waiver Renewal

Prepared by the Massachusetts Child and Adolescent Health Initiative with support from Manatt Health, the Center for the Study of Social Policy and independent consultant Donna Cohen Ross

The COVID-19 pandemic and the spotlight on racial inequities have exposed and intensified the immense pressure on Massachusetts’ families, making this a critical time to remake and strengthen MassHealth, the combined CHIP and Medicaid program in Massachusetts, to support the Commonwealth’s children. Although MassHealth cannot solve all the difficulties confronting our children, it can support a family-based approach to pediatric care; help tackle social issues, economic challenges and systemic discrimination; elevate and integrate behavioral health into pediatric primary care; expand the use of community health workers; and systematically reflect the experiences and voices of the families served by MassHealth.

In pursuit of these goals, the Massachusetts Chapter of the American Academy of Pediatrics supported a multisector Child and Adolescent Health Initiative (CAHI) developing MassHealth recommendations for the upcoming MassHealth Section 1115 waiver to strengthen care for Massachusetts’ one in three children enrolled in MassHealth. In addition, CAHI included actions that the Massachusetts Executive Office of Health and Human Services could take now using existing authority to strengthen care for children and their families, as well as leveraging the contract reprocurements for the Commonwealth’s accountable care organizations and managed care organizations. To support these recommendations, CAHI engaged Manatt Health, the Center for the Study of Social Policy and independent consultant Donna Cohen Ross to provide technical assistance and policy contributions. Funding for this assistance was generously provided through Pediatrics Support Parents, a joint initiative supported by a consortium of funders aimed at supporting and improving young children’s social and emotional development through pediatric primary care.

In “Moving to the Vanguard on Pediatric Care: Child and Adolescent Health Initiative Recommendations for the MassHealth Section 1115 Waiver Renewal,” Manatt Health and CAHI published recommendations designed to accomplish the following:

  • Ensure that the Section 1115 waiver renewal includes a robust focus on the needs of children, youth and their families, allowing for more investment in upstream and primary prevention that managed care plans otherwise are unlikely to make.
  • Adopt a pediatric-specific approach to financing care for children, reflecting that most investments in pediatric care generate longer-term or cross-sector savings that do not lend themselves to traditional value-based payment models focused on short-term shared savings.
  • Recognize the primary role of parents and other primary caretakers in children’s health by addressing their needs and supporting the parent-child relationship.
  • Assist in tackling the social and economic challenges, including systemic racism and inequalities, that have an outsized impact on child health and well-being.

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