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> Amendments to the Budget
> Mobile Integrated Health
> A New Era at Cape Cod Hospital
> Transition

MONDAY REPORT

MHA’s Priority Amendments to the House FY2026 Budget

This week, the Massachusetts House begins formal debate on the House Ways and Means $61.4 billion FY2026 state budget proposal. MHA’s nine priority amendments are among the 1,650 amendments that were filed.

Most of MHA’s focus is on two key issues placing significant strain on the state’s healthcare system: the growing financial shortfall in the Health Safety Net (HSN) and increasing restrictions on the federal 340B Drug Pricing Program.

The Health Safety Net Trust Fund, which supports care provided to low-income, uninsured, and underinsured patients at hospitals and community health centers across the commonwealth, continues to face mounting deficits that jeopardize its ability to support these essential services. Hospitals and insurers each pay $165 million into the fund annually to fund it. By statute, the state is required to add $30 million, but annually the budget is drafted to require the state to contribute “up to $15 million.”

When the cost of care exceeds the available funds, hospitals and health systems alone are responsible for covering the shortfall. In FY2024, the Health Safety Net faced a $198 million shortfall. That gap is expected to grow, with projected deficits exceeding $230 million in FY2025 and potentially reaching $260 million in FY2026.

Rep. Dan Cahill (D-Lynn) filed Amendment 419 to address the Health Safety Net funding problem in two ways. First, it would require commercial health insurers to contribute to the Health Safety Net shortfall as opposed to having hospitals absorb the deficit on their own. Second, the amendment would update the state’s statutory funding requirement by setting the annual contribution at $60 million and strengthening the language that requires the commonwealth to provide consistent, meaningful financial support.

In a complementary effort, Amendment 1251, filed by Rep. John Lawn (D-Watertown), would allocate new funding to directly address the program’s ongoing deficits. The amendment would authorize a transfer from the Commonwealth Care Trust Fund to the Health Safety Net Trust Fund. Under state law, such transfers to the HSN are explicitly allowed to help reimburse hospitals and community health centers for eligible health services. As of the most recent reports from the state comptroller note, the Commonwealth Care Trust Fund held over $400 million at the end of FY2023, more than $500 million at the end of FY2024, and maintains a balance of more than $367 million in FY2025—with additional revenues expected before the end of the fiscal year. This transfer could also qualify the state for up to $115 million in federal matching funds, assuming $230 million is invested in the Health Safety Net.

Beyond the Health Safety Net funding crisis, MHA is also backing two amendments aimed at protecting access to the federal 340B Drug Pricing Program, which allows eligible hospitals and health centers to purchase prescription drugs at discounted rates and reinvest the savings into patient care. Amendment 635, filed by Rep. Kate Lipper-Garabedian (D-Melrose), would enhance current state statute to prevent actions by the Executive Office of Health and Human Services (EOHHS) that could restrict hospital access to 340B savings.

And Amendment 1407, filed by Rep. Adam Scanlon (D-North Attleboro), seeks to protect 340B providers from discriminatory practices by by drug manufacturers, pharmacy benefit managers (PBMs) and commercial health insurers. The amendment would prohibit such entities from imposing different reimbursement terms, exclusions, or conditions on 340B providers compared to other providers, an approach already adopted in numerous other states. The goal is to preserve the original intent of the 340B program by ensuring that savings benefit the patients of safety net hospitals and community health centers, rather than enlarging the profit margins of drug companies and others.

Coverage Needed for Mobile Integrated Health Programs

Faced with inarguable facts – hospitals are filled to capacity, emergency wait times are spiking, and transfers between care facilities are so stymied that patients are stuck in inpatient beds – hospitals have turned to innovative practices to ease the burdens for patients and for themselves.

One such care model that gained prominence during the pandemic is “mobile integrated health” in which paramedic-led care teams bring care to patients in locations outside of hospital walls – to homes, shelters, and even the streets in the cases of the unhoused. These MIH programs, reviewed and approved by the Department of Public Health, ensure that patients receive appropriate care services while minimizing hospital readmissions and unnecessary visits to emergency departments. The problem? Health insurance companies have consistently refused to pay for them. Many such services to date have been funded through grants and donations, which are largely unsustainable in the long term.

Tomorrow, April 29, the legislature’s Joint Committee on Financial Services is holding a hearing on companion bills that could finally resolve the insurer disconnect. H.1154/S.726, An Act Relative to Insurance Coverage of Mobile Integrated Health, sponsored by Rep. Michael Finn (D-West Springfield) and Sen. Bill Driscoll (D-Milton) would disallow public and private health plans from refusing to cover healthcare services on the basis that they were delivered by a state-approved mobile integrated health program. The bills require that such services be covered to the same extent as they would have had they been provided in a healthcare facility, and would lift application and registration fees for MIH programs that are focused on delivering behavioral health services.

Getting insurance coverage for MIH programs has long been an MHA priority, with the bill having been introduced in previous sessions. This time around, with more evidence that MIH programs save money, reduce readmissions, improve patient care access, and ease pressure on hospital EDs, the hope is that insurance reforms will finally make them viable on a permanent basis.

A recent article in Health Affairs focused on how UMass Memorial Health’s MIH program is reducing costs and improving care. UMass researchers published a study in the Journal of the American Medical Directors Association showing that the risk of 30-day rehospitalization was lower in a group of patients served by the MIH program compared to the control group.

Cape Cod Healthcare Cuts Ribbon on Four-Story Pavilion

Cape Cod Healthcare held a ribbon cutting for its new Edwin Barbey Patient Care Pavilion at Cape Cod Hospital last Thursday.

The first two floors of the four-story, 141,148-square-foot pavilion house the outpatient Davenport-Mugar Cancer Center, with 36 private infusion bays, and expanded radiation therapy facilities that include two linear accelerators. The new cancer center will begin serving patients on May 12, 2025.

The upper floors are slotted to open later in 2025. The third floor is dedicated to cardiovascular care for patients, while the fourth floor will provide 32 medical/surgical beds to accommodate the growing demand for surgical services at Cape Cod Hospital. Each patient room in the pavilion is designed for single occupancy.

“This building will treat tens of thousands of people for generations to come and we’ll know it’s a place where empathetic care was provided, where people were cured, and where wonderful experiences were shaped,” Michael Lauf, president and CEO of Cape Cod Healthcare and the current chair of the MHA Board of Trustees, said at the ribbon-cutting, which was attended by Cape Cod patients, clinical leaders, community members, and state officials.

The Edwin Barbey Patient Care Pavilion was made possible in part by a $10 million donation from the Edwin Barbey Charitable Trust, directed by Peter and Pamela Barbey of Hyannis Port.

Transition

Tim Foley, longtime leader of the 11999SEIU labor union and a former commissioner of the Health Policy Commission, is UMass Memorial Health’s new vice president of government relations as of today. Foley served in numerous executive roles over his nearly 20 years at 1199SEIU, including Executive Vice President and Massachusetts Division Director. He will lead the UMMH system’s legislative efforts.

John LoDico, Editor