H 4933 requires Massachusetts health insurance plans to cover colorectal cancer screening with no out-of-pocket costs for people aged 30 and older. It applies to Commonwealth employees (active and retired), Medicaid recipients, private insurance policies, and employer health plans. The law mandates coverage for multiple screening methods - including colonoscopy every 5-10 years, annual stool tests, and other medically necessary procedures - as recommended by a doctor. Crucially, it eliminates copays, deductibles, and other cost-sharing for these screenings, except for tax-exempt plans that would lose status if cost-sharing were prohibited.
This bill (H 4958) requires all health insurance plans in Massachusetts - covering Commonwealth employees, Medicaid recipients, and private insurance policies - to provide full coverage for medications treating opioid use disorder, including opioid antagonists and agonists (like methadone or buprenorphine). It eliminates prior authorization requirements and removes all out-of-pocket costs (deductibles, copays, coinsurance) for these medications, treating them as medically necessary. The coverage applies whether the medication is dispensed by a pharmacy or administered at a treatment facility, with facilities reimbursed at standard rates to prevent balance billing. This directly affects patients seeking opioid use disorder treatment and the insurers/health plans providing their coverage.
This bill directs Massachusetts' Executive Office of Health and Human Services to form a working group to study how state colleges and universities can claim federal Medicaid funds (Title XIX) for health services provided to students covered by MassHealth. It specifically examines opportunities for students of all ages, including those with disabilities and those eligible for both Medicaid and Medicare, as well as administrative and programmatic approaches to claiming these funds. The working group must produce a report by April 2027, including financial estimates of potential revenue, challenges, and a preliminary plan for pursuing these funds. The bill does not change current law but initiates a study to explore potential new revenue streams for public colleges.
This bill caps the out-of-pocket cost for insulin at $100 per 30-day supply for all patients, regardless of insulin type or prescription amount. It requires pharmaceutical companies with Medicaid rebate agreements to offer free 30-day insulin supplies to individuals urgently needing insulin (with less than 7 days' supply) who meet income criteria (≤400% of federal poverty level) and lack private drug coverage. Eligible individuals must provide proof of financial need and have a prescription. The cap applies to all insurers, manufacturers, and government programs covered under the bill, ensuring consistent cost limits without requiring additional coverage.
This bill requires most health insurance plans in Massachusetts to cover pain management during IUD insertion with no out-of-pocket costs for patients. It applies to state employee group insurance (Chapter 32A), Medicaid plans (Chapter 118E), private accident/sickness insurance (Chapter 175), and hospital service plans (Chapter 176A). The law mandates coverage for specific methods like IV sedation, nitrous oxide, or topical anesthesia without deductibles, copays, or unreasonable delays, and extends benefits to covered spouses and dependents. Religious exemptions for church employers are included, requiring written notice to enrollees about excluded services. The bill directly affects insurance providers and enrollees using these coverage types for IUD procedures.
H 4939 requires health insurers and Medicaid plans to cover patient navigation services provided by certified community health workers. These services help patients access care by addressing chronic disease prevention, social needs screenings, health education, and overcoming barriers like language or health literacy. The bill mandates reimbursement for workers with national certification or approved training, effective January 1, 2026. It directly affects Medicaid-eligible patients and community health workers by expanding access to coordinated care support. The law also directs the Executive Office of Health and Human Services to secure federal funding for implementation.
This bill (H 4934) requires Massachusetts Medicaid insurers to cover non-opioid pain medications equally with opioids - prohibiting restrictions like labeling them "non-preferred" or imposing stricter prior authorization. It mandates comprehensive care coordination for Medicaid members with chronic pain, including access to integrated services (primary care, specialists, physical therapy, mental health) and individualized treatment plans by 2027. The bill also directs the state to collect data on chronic pain incidence, demographics, treatment costs, and care gaps, publishing reports every two years starting in 2028. These provisions directly affect Massachusetts Medicaid enrollees with chronic pain and their healthcare providers.
This bill requires health insurers with reserves exceeding 550% of risk-based capital to pay an assessment generating $400 million total. The funds are split equally: $200 million goes to the Health Safety Net Trust Fund (supporting community health programs) and $200 million to the Medicaid Stabilization Trust Fund (preventing access cuts for MassHealth beneficiaries). The assessment applies to insurers meeting specific reserve thresholds set by the Division of Insurance, with enforcement mechanisms including interest charges for late payments. The program expires on December 31, 2026.
H 4894 defines specific mental health treatment services - including acute inpatient care, crisis stabilization, and community-based options for children and adults - and eliminates preauthorization requirements for coverage. It directly affects Commonwealth employees (active and retired) under Group Insurance Commission plans and Medicaid beneficiaries. The bill mandates that facilities notify insurers within 48 hours of admission for all services, with utilization review permitted to begin after 7-10 days, while requiring medical necessity to be determined by the treating clinician and documented in the patient’s record. This streamlines access to critical mental health care by reducing administrative barriers for defined services.
This bill requires most health insurance plans in Massachusetts to cover FDA-approved epinephrine injectors (auto-injectors or pre-filled syringes) for weight-based dosing without higher out-of-pocket costs than other prescribed drugs. It directly affects Commonwealth employee insurance, Medicaid, private health insurance plans, and employer health funds by mandating this coverage. Key provisions ensure no additional deductibles, copays, or coinsurance apply specifically to these injectors compared to standard medications. The law applies to all relevant insurance policies delivered or renewed in Massachusetts, focusing solely on coverage requirements for existing FDA-approved devices.
