With Medicaid cuts looming, new report sounds the alarm for aggressive state government action

AARP thanks the Massachusetts House for passing H.4706, An Act to Improve Massachusetts Home Care, creating the state’s first Family Caregiver Commission. During National Family Caregivers Month, we urge the Senate to pass this vital bill and give the state’s 1.4 million caregivers the support they deserve. Learn more: aarp.org/ma

When President Trump signed the “One Big Beautiful Bill Act” earlier this year, there was a time bomb tucked inside that will force Massachusetts to grapple with massive changes to Medicaid.

MassHealth — the state’s Medicaid program covering more than 2 million people, including low-income children and seniors — is one of the biggest items in the budget that Beacon Hill grapples with every year. New work requirements would hit the state budget and health care system halfway through fiscal year 2027, leading to tens of thousands losing coverage while adding administrative costs and strain to an already struggling health care system.

How do you deal with a time bomb? Deploying a strike force, even if it’s to contain the blast radius, is one option. That is among the suggestions in a new report from Boston Indicators, the research arm of the Boston Foundation, and the Center for State Policy Analysis at Tufts University.

The report calls for a command team, similar to one Gov. Charlie Baker set up during the COVID pandemic, and centered inside the governor or lieutenant governor’s office, to “mobilize the necessary cross-agency cooperation” needed to roll with the changes to Medicaid.

“In a saner world, the Medicaid work requirements introduced in OBBBA would be deliberately phased in, starting with clear explication and paired with robust technical assistance from the federal government — not to mention ample opportunity for collaboration between states,” the report said. “As it stands, however, Massachusetts will have to act fast and find guidance on its own.”

The tight window for action involves regulatory details coming from the feds in June 2026, months before states must give residents a heads up about the new requirements and the full implementation required in January 2027. States can request a delay, but it requires federal sign-off.

“Waiting for near-final rules to arrive next summer would make it impossible for Massachusetts to adapt its enrollment procedures, which means we’ll need to start developing a Massachusetts Model for successful implementation before the final rules are even available,” the report added.

Good intentions won’t be enough, the researchers said. Older hands on Beacon Hill will remember the technological mess from more than a decade ago, when Gov. Deval Patrick was forced to fix a health insurance website that didn’t work. The company hired to handle the tech was fired.

“Tens of thousands of at-risk residents need us to develop a Massachusetts Model for successful implementation of OBBBA — before the starting bell in January 2027,” researchers said. “Otherwise, we’ll be just another place where people lose insurance thanks to overly complicated forms or because vital information about their work history can’t be shared across state agencies.”

Researchers said automation will be key: The state should be able to automatically check incomes and confirm compliance, and “identify allowable exemptions by linking disparate data systems from across state agencies and relevant private sources.” Sign-ups should be streamlined, and the state should set up an outreach plan for applicants and MassHealth members.

Legislative intervention might also be required, by turning to an already existing program and turbo-boosting it by moving from ad-hoc reimbursements to helping with access to primary care and emergency care, they said. “Even if we do everything right, some people are still going to lose insurance, either because of their immigration status or because they fall through lingering cracks,” they wrote. “Fortunately, the state already provides emergency coverage for uninsured individuals through our Health Safety Net program.”

As Adam West’s Batman once said, “Some days you just can’t get rid of a bomb.” What’s your take on these suggestions to help contain the blast radius? Let me know: [email protected].

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8:30 | The Group Insurance Commission meets. Agenda includes a report from Executive Director Matt Veno. Members will also discuss the GIC's "potential options" to handle fiscal 2027 budget constraints, according to the agenda. | More Info and Livestream

9:00 | Researchers from the Boston Foundation and Tufts University release their report, “Massachusetts Model for Medicaid Work Requirements.” A panel discussion is also on the agenda, with Tufts University’s Evan Horowitz, Harvard School of Public Health’s John McDonough, and former Baker administration health chief Marylou Sudders. | Virtual

9:00 | Boston Mayor Michelle Wu is live on “Java with Jimmy.” | Virtual

10:00 | The MBTA Board meets. | 10 Park Plaza, Boston | More Info

10:00 | The Mass. Gaming Commission meets. | Agenda and Access

11:30 | Gov. Maura Healey hosts a press conference urging President Trump to immediately release Low-Income Home Energy Assistance Program (LIHEAP) funding. She is joined by Lt. Gov. Kim Driscoll, Housing and Livable Communities Secretary Ed Augustus, and Energy and Environmental Affairs Secretary Rebecca Tepper. | Governor’s Reception, State House, Boston

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SUMMERS DONATIONS: Lawrence Summers, the former Harvard president under fire for his connections to convicted sex offender Jeffrey Epstein, was a donor to top Massachusetts Democrats, according to a review of campaign finance records. Gov. Maura Healey, who received money while she was attorney general, is donating the money she received from Summers to a Boston nonprofit. – Axios Boston

BOSTON REP ON SHUTDOWN: Rep. Russell Holmes, a Mattapan Democrat, criticized Sens. Ed Markey and Elizabeth Warren for their stances during the federal government shutdown, saying “it’s disappointing to me that my two senators are taking positions so liberal that they are not in the conversation.” – Dorchester Reporter

2026 ‘WATERSHED’: Bill Galvin, the Massachusetts elections chief, is predicting a “watershed” year for ballot questions as organizers of various proposed initiatives sought to meet a signature-gathering deadline. Proposals range from a return to rent control to legalization of starter homes and lowering the state income tax. – MassLive

STATE RECORDS: The closeout budget state lawmakers sent to Gov. Maura Healey includes a provision that helps family members obtain records of people with disabilities who lived in institutions. – GBH News

TARIFF TALK: Gov. Maura Healey said her previous opposition to two gas pipelines didn’t contribute to rising energy costs as she took aim at President Trump’s tariffs on Canadian products for increases in housing and energy costs. – Boston Herald

ELECTION REFLECTION: Frank Baker reflected on placing fifth in the Boston City Council at-large race, 15,000 votes behind fourth-place finisher Henry Santana despite raising $300,000 and racking up endorsements from current and former local officials like Marty Walsh. – Dorchester Reporter

BATTERY BOOM: Some city and town residents are fighting the placement of energy storage facilities as state officials say the batteries will help bring down utility bills. – WBUR

CITY HALL MERCH: Boston City Hall officials are continuing to explore the sale of official merchandise branded with city department logos. – Boston Globe

ADU REVIEW: Massachusetts is falling behind the west coast on construction of accessory dwelling units, also known as granny flats, according to a new report by the Pioneer Institute. – Boston Business Journal

QUINCY TAX BREAK: Quincy councilors approved a 13-year tax break for real estate developer Grossman Cos. for a residential project off Burgin Parkway in the city’s downtown area. – Patriot Ledger

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