Category Archives: Massachusetts

Robbing Peter to Pay Paul: Problems in Enforcing the Medicaid Secondary Payer Requirements

One of the things that gets drummed into your head working with Medicaid is this:  Medicaid is a payer of last resort.  Medicaid can only pay for a health care service when there is no other payer available.  If a Medicaid beneficiary has virtually any other source of health insurance coverage, that coverage pays first.

This requirement is set forth in the basic rules of the Medicaid program;… More

Massachusetts House Pushes Medicaid Supplemental Rebate Law in Budget

On April 11, 2019, the Massachusetts House Committee on Ways and Means released its FY 2020 budget (H.3800).  The legislation includes provisions authorizing MassHealth (the Massachusetts Medicaid program) to negotiate supplemental rebates directly with drug manufacturers, and provides for further proceedings before the Health Policy Commission for manufacturers refusing to negotiate supplemental rebates at levels satisfactory to the Commonwealth. These provisions represent amendments to a MassHealth drug pricing proposal included in Governor Baker’s FY 2020 filing in January.… More