EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
COMMONWEALTH OF MASSACHUSETTS
OFFICE OF MEDICAID
ONE ASHBURTON PLACE, BOSTON, MA 02108
MAURA T. HEALEY KATHLEEN E. WALSH
GOVERNOR SECRETARY
KIMBERLEY DRISCOLL MIKE LEVINE
LIEUTENANT GOVERNOR ASSISTANT SECRETARY
FOR MASSHEALTH
August 23, 2023
Chair, Michael J. Rodrigues Chair, Aaron Michlewitz
Senate Committee on Ways and Means House Committee on Ways and Means
State House, Room 212 State House, Room 243
Boston, MA 02133 Boston, MA 02133
Chair, John C. Velis Chair, Adrian Madaro
Joint Committee on Mental Health, Joint Committee on Mental
Substance Use and Recovery Health, Substance Use and Recovery
State House, Room 513 State House, Room 134
Boston, MA 02133 Boston, MA 02133
Dear Chairs Rodrigues, Michlewitz, Velis, and Madaro,
Section 2YYYY of Chapter 29 of the Massachusetts General Laws requires the Executive
Office of Health and Human Services (EOHHS) to submit to the House and Senate
Committees on Ways and Means and the Joint Committee on Mental Health and
Substance Use and Recovery a detailed accounting of all monies transferred, credited, or
deposited into the Substance Use Disorder Federal Reinvestment Trust Fund (SUD Trust
Fund).
Revenues credited to the SUD Trust Fund include the amount equal to the sum of federal
financial participation received by the Commonwealth's General Fund for expenditures
for residential recovery services, transitional support services, family recovery services,
recovery support navigator services, recovery coach services, other new or expanded
substance use disorder treatment services, and any other federal reimbursements, grants,
premiums, gifts, interest, or other contributions from any source received that are
specifically designated to be credited to the SUD Trust Fund.
Expenditures from the SUD Trust Fund include payments for SUD service enhancement
and expansion in accordance with priorities articulated in the SUD Trust Fund statute,
namely: the expansion of co-occurring enhanced Residential Rehabilitation Services;
expansion of medication for addiction treatment (MAT); addition of Peer Recovery
Coaches and Recovery Support Navigators services as a benefit; and implementation of
American Society of Addiction Medicine (ASAM) based assessments, treatment
planning, and care delivery. The SUD Trust Fund is critical to maintain the enhancement
and expansion of substance use disorder services and meet the needs of individuals across
the Commonwealth seeking treatment and recovery from substance use disorders and co-
occurring mental health disorders.
The total annual investment has increased based on both additional programs coming
online and increases in service utilization. For Fiscal Years (FY)18-22, the SUD Trust
Fund expenditures primarily supported the establishment and incremental development of
new services authorized under MassHealth’s 1115 demonstration waiver that were
prioritized for investment through the SUD Trust Fund.
SUD Trust Fund investments to implement new benefits (FY18-22)
Co-occurring Enhanced Residential Rehabilitation Services: Based on the prevalence
of co-occurring mental health and substance use disorders and the lack of dedicated
residential resources intended to serve this population, the expansion of new residential
rehabilitation services (RRS) capacity through the SUD Trust Fund has focused on this
co-occurring enhanced level of care. The service model was developed and implemented
as a collaborative effort by MassHealth and the Department of Public Health through
multiple waves of procurement, Since 2018, additional programs came online and began
providing services to individuals throughout the Commonwealth. By the end of FY22,
approximately 400 new beds have opened, increasing total RRS capacity statewide by
roughly 20%. All MassHealth managed care entities, and the Department of Public
Health, pay for co-occurring enhanced RRS services in a standardized and
administratively streamlined manner, utilizing an identical set of program specifications.
Peer Recovery Coaches and Recovery Support Navigators: In FY19, MassHealth and
its managed care entities began covering Peer Recovery Coach and Recovery Support
Navigator services. These services are intended to leverage both peers with lived
experience and trained paraprofessionals to aid individuals in seeking treatment and
maintaining recovery. As additional providers established Peer Recovery Coach and
Recovery Support Navigator programs, and a greater number of individuals across the
Commonwealth received the service, expenditures in this category have also increased.
Additionally, the proposed creation of the Recovery Coach Board of Registration, as
recommended by the Recovery Coach Commission, could further expanded adoption and
provision of Peer Recovery Coach services.
SUD Trust Fund expenditures to date (FY18-22) are associated with the establishment
and ramp up of these new services. Spending increased in FY21 and in FY22 based on
continued implementation and expansion.
 FY18 FY19 FY20 FY21 FY22
($ in millions)
Actual Actual Actual Actual Actual
Revenue
Existing Balance $2.9 $27.5 $117.3 $158.8
Federal Revenue $6.1 $35.6 $117.4 $106.8 $149.0
Subtotal Revenue $6.1 $38.5 $144.9 $224.1 $307.8
Payments
Residential Rehabilitation Services
$2.6 $6.7 $17.8 $41.0 $79.8
(RRS)
Peer Recovery Coach (RC)/Recovery
$0.6 $3.5 $9.8 $11.6 $18.0
Support Navigator (RSN) Services
MAT Expansion $0.8
ASAM $12.7 $36.9
Subtotal Payments $3.2 $11.0 $27.6 $65.3 $134.7
Future Investments
Over the next five years, EOHHS anticipates that spending from the SUD trust will
significantly exceed revenues, resulting in the balance being spent down by FY27. The
continued increase in spending above FY22 levels will be driven by (1) increased
spending on existing services and (2) coverage of new services. Existing core SUD
services include acute treatment services, clinical stabilization services, residential
rehabilitation services, and peer supports. New rates and initiatives including bundled
payments for opioid treatment programs and rate investments in 24-hour levels of care
will help to provide critical access to care for members. The introduction of new and
innovative services supports the trust spend down while offering critical access to
members with substance use disorder needs, such as the Community Behavioral Health
Centers access to MAT, Peer Recovery Supports in emergency departments and primary
care provider (PCP) integration.
Conclusion
In summary, as a result of the continued expansion of new Co-occurring Enhanced
Residential Rehabilitation Services, Peer Recovery Coach services, and Recovery
Support Navigator services, as well as the new investments in MAT and 24-hour SUD
programs in line with ASAM, total SUD Trust Fund expenditures over the five-year
period have exceeded $240M.
Thank you for your continuing commitment to the MassHealth program. If you have any
questions about this report, please contact Sarah Nordberg at Sarah.Nordberg@mass.gov.
Sincerely,
Mike Levine
cc: Kathleen E. Walsh