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May 1, 2006


Romney submits plan to federal government, forms new Medicaid fraud unit

Governor Willard Mitt Romney (MA)

Implementation of Health Care Law Proceeds

Location: Boston, MA


Governor Mitt Romney announced today that his administration has hit the first milestone in the implementation of the new health insurance law by submitting to the federal government for approval a comprehensive plan detailing how it will substantially reduce the number of uninsured in the Commonwealth.


Romney also announced the formation of the MassHealth Fraud Prevention unit to insure the integrity of the $7 billion per year program, funded by $1.5 million in the health care reform bill. Until now, MassHealth had several programs in different parts of the agency addressing the issue of fraud.


Approval by the federal Centers for Medicare and Medicaid Services (CMS) is required to maintain the availability of $385 million of federal Medicaid funding during each of the next two fiscal years. Last year, CMS advised Massachusetts to submit its plan by January 15, noting that a minimum of 120 days would be needed to review the proposal without jeopardizing the continuous availability of the $385 million after July 1. The state missed that deadline as health care reform was not passed by the Legislature until April.


“Despite the legislative delays, it is our hope that our partners in the federal government will expedite their review and approve the Commonwealth’s plan by July 1,” said Romney. “We will be aggressive in our efforts to secure the maximum level of federal funding and stand ready to provide any and all additional information that may be required.”


Romney said a rapid response team comprised of Health and Human Services and MassHealth staff has been assembled to assist the CMS review process.


Health and Human Services Secretary Tim Murphy said: “Implementation will be just as challenging as getting the legislation passed, but it is a challenge we relish. We look forward to working closely with the federal government and other stakeholders to make health care insurance available to every resident of Massachusetts.”


According to the plan filed today, the recently approved health insurance law accomplishes the following key goals sought by the federal government:


  • Subsidizes the purchase of private insurance for low-income individuals to reduce the number of uninsured;
  • Directs more federal and state dollars to individuals and less to institutions; and
  • Improves the fiscal integrity of the MassHealth program.


Key milestones in the timeline submitted as part of the plan include the operationalization of the Connector Authority between May and October, the offering and enrollment of lower-income residents into premium assistance programs by October, the offering of private, non-subsidized products by January, and statewide open enrollment between March and May 2007 in anticipation of the individual insurance requirement that starts July 1, 2007.


Meanwhile, the Legislature and the Executive branch are redoubling efforts to ensure program integrity in MassHealth.


MassHealth is also planning a comprehensive effort to re-credential its providers. The effort, suggested by national program integrity experts consulted by MassHealth, will begin with an immediate targeted review of high-risk providers.


“We’ve created this unit to build and document a coordinated process of detecting, identifying and referring suspected fraud and abuse within both the provider and member communities,” said Massachusetts Medicaid Director Beth Waldman. “Centralization will allow MassHealth to direct resources strategically and provide an efficient way to inform providers and members that we take fraud very seriously.”


“We believe re-enrolling our providers will pay dividends and reduce risk to the program,” said Murphy. “And we are confident that the creation of the Fraud Prevention Unit will enhance our efforts to build an efficient and sound system for fraud and abuse identification and referral in MassHealth.”


Massachusetts’ full submission to CMS is available at www.mass.gov/eohhs.

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