Massachusetts
Massachusetts isn’t using a tool that could help tackle its shortage of primary care doctors – The Boston Globe
When Massachusetts is a national outlier in any policy, it’s worth asking why and whether that policy still makes sense.
Massachusetts today is one of only seven states that does not use Medicaid money to fund medical residencies, which provide the clinical training of new doctors after they complete medical school. Among the 10 states with the most teaching hospitals and physician residents, it is the only one that does not use Medicaid money to support graduate medical education, or GME, according to the Association of American Medical Colleges.
The main reason appears to be cost: Massachusetts did have a program, but policy makers cut it in 2010, according to the Executive Office of Health and Human Services, amid budget shortfalls due to the 2008 recession and as state officials prioritized implementing universal health insurance coverage.
Today, cost remains a barrier to reinstating the program. Yet given the shortage of primary care physicians, lawmakers should consider reinstating Medicaid GME in a targeted way that shores up needed services like primary care, behavioral health care, and community health centers.
Without the Medicaid money, residencies are mostly paid for by Medicare, which gave $16.2 billion in fiscal 2020 to GME programs nationwide.
Although it may seem like an arcane distinction, there are two good reasons to use Medicaid money to fund residencies beyond those funded by Medicare. One is that the federal government would match the state contribution, drawing new federal money. The second is that the state can narrowly tailor a Medicaid program to decide how much money to spend — and how to spend it.
This flexibility means state lawmakers could target money for residencies in specific specialties that Massachusetts needs more of.
There is a dire need to train more primary care physicians and keep them in Massachusetts. People are struggling to find doctors. Wait times at community health centers, which see many Medicaid patients, have recently been as long as 80 days for a new patient and up to 40 days for an existing patient, according to Michael Curry, president and CEO of the Massachusetts League of Community Health Centers.
According to the Milbank Memorial Fund’s primary care scorecard, 16.7 percent of adults in Massachusetts and 5.4 percent of children in 2021 lacked a usual source of health care, numbers that had grown since 2011. According to survey data from Massachusetts Health Quality Partners and the Center for Health Information and Analysis, adults were having a harder time accessing primary care in 2022 than in 2019. Massachusetts has a higher rate of doctors leaving primary care than the nation overall. One-third of Massachusetts doctors in 2020 were over 60 and fewer than one-quarter of Massachusetts medical school graduates are entering primary care, according to MHQP.
When someone cannot get an appointment with a primary care physician, they are more likely to become seriously ill and go to the emergency department, at a time when hospitals are experiencing capacity crunches.
Funding more residency training slots through Medicaid would not magically solve the problem. Seriously addressing the primary care shortage will require paying primary care doctors more and addressing the administrative burden that makes primary care such a hard job. Massachusetts officials are taking other steps to address the problem, like establishing student loan repayment programs.
But reestablishing Medicaid GME could allow hospitals and community health centers to train more doctors to work in badly needed fields. Because specialty care is more lucrative, without the added Medicaid incentive, hospitals are more likely to create residencies in specialty fields than primary care.
Multiple bills to reestablish Medicaid GME payments are pending in legislative committees, with advocacy by the League of Community Health Centers and the Massachusetts Health and Hospital Association. The details differ, but the basic idea is to pay for residencies in fields with shortages, including primary care and behavioral health care, in hospitals and community health centers. (Like primary care, behavioral health care is a field where worker shortages are severely impacting people’s ability to get timely care.) A program could also potentially fund training for non-physician clinicians, like nursing students.
The League of Community Health Centers is asking for $50 million in Medicaid funding over three years, half of which would be reimbursed by the federal government. According to the organization, that level of funding would pay to graduate 23 new family medicine doctors annually (with funding for three years of residency) and to fund 69 residency slots each year for nurse practitioners, assuming a cost of $185,000 per physician resident and $120,000 per nursing resident.
Most states use general fund money to pay for Medicaid GME, though some rely on municipal tax money or taxes on hospitals. Lawmakers will have to determine the best funding source.
But the money is likely to be a smart investment, and it will draw in federal money that the state is leaving on the table now. And if increased funding for residencies means more doctors go into primary or behavioral health care in Massachusetts, patients will be seen sooner and will get the care they need to remain healthy, lowering costs in the long term.
Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.
Massachusetts
New Bedford MS-13 Member, Illegal Alien Pleads Guilty to Role in Brutal Murders In Massachusetts, Virginia
Frankli
Police shot and killed a man who officials say rushed officers with a knife during a call in Lexington, Massachusetts, on Saturday.
Middlesex County District Attorney Marian Ryan said the situation started around 1:40 p.m. when Lexington police received a 911 call from a resident of Mason Street reporting that his son had injured himself with a knife.
Officers from the Lexington Police Department and officers from the Northeastern Massachusetts Law Enforcement Council (NEMLEC), who were already in town for Patriots’ Day events, responded to the call.
Police were able to escort two other residents out of the home, initially leaving a 26-year-old man inside. According to Ryan, while officers were setting up outside, the man ran out of the home and approached officers with a large kitchen knife.
She added that police tried twice to use non-lethal force, but it was not effective in stopping him. The man was shot by a Wilmington police officer who is a member of NEMLEC. The man was pronounced dead on scene and the officer who fired that shot was taken to a local hospital as a precaution.
The man’s name has not been released.
Ryan said typically in a call like this where someone was described as harming themselves, officers would first try to separate anyone else to keep them out of danger, which was done, and then standard practice would be to try to wait outside.
“It would be their practice to just wait for the person to come out. In the terrible circumstances of today, he suddenly rushed the officers, still clutching the knife,” Ryan said.
The investigation is still in the preliminary stages and more information is expected in time. Ryan said her office will request a formal inquest from the court to review whether any criminal conduct has occurred, which is the standard process.
This happened around the same time as the annual Patriots’ Day Parade, and just hours after a reenactment of the Battle of Lexington, which drew large crowds to town.
This is a developing story. Check back for updates.
Massachusetts
‘An impossible choice’: With little federal help to combat rising costs, Head Start looks to Massachusetts for more help – The Boston Globe
In Massachusetts, roughly 1,300 slots for children across Head Start’s 28 agencies have been eliminated in the last three years because federal funding has plateaued over that time, while the cost of running the program continues to rise, according to the Massachusetts Head Start Association. Nationally, Head Start enrollment dropped from 1.1 million kids in 2013 to around 785,000 in 2022, according to research by the Annie E. Casey Foundation.
“If they didn’t get into a Head Start program, they would be sitting at home,” said Brittany Acosta, a Head Start parent in Dorchester.
It’s teachers are drastically underpaid, and there’s a serious need for a rainy day-type fund should the federal government shut down again, the association says. As they’ve done in years past, state lawmakers have offered to provide financial relief, but the Massachusetts Head Start Association’s request for 3 percent above the amount it received last year, an additional $4.6 million to help its staff keep up with the state’s rising cost of living, so far has not been allocated.
Last year, President Trump’s leaked budget proposal revealed he considered eliminating Head Start entirely. Then, in the summer, he cut off Head Start enrollment for immigrants without legal status. And during the fall’s government shutdown, four Head Start centers in Massachusetts closed because they couldn’t access their funding.
Trump’s latest budget proposal shows a fourth year without increasing funding for the program, which was established in the mid-1960s.
Michelle Haimowitz, executive director of the Massachusetts Head Start Association, said the program doesn’t want to eliminate more child slots than it already has, but paying teachers a competitive salary is equally important in order to keep them from leaving for higher paying jobs. Head Start teachers make under $50,000 annually compared to over $85,000 for the average Massachusetts kindergarten teacher.
“It’s an impossible choice,” Haimowitz said. “When we reduce the size of our programs, we’re not reducing the size of the need.”
Massachusetts is one of few states that supplements federal funding for Head Start, and last year it increased the program’s state grant from $5 million to $20 million, adding to the $189 million in federal aid it receives in this state.
“We can’t run a program without giving staff a raise for three years,” Haimowitz said. “Our next fight now is not just for survival, but it’s for thriving and growth.”
The Massachusetts House Ways and Means Committee on Wednesday released its budget, which doesn’t grant Head Start’s request of a 3 percent boost. But state Representative Christopher Worrell filed an amendment for additional funding. Worrell, whose district covers parts of Dorchester and Roxbury, said he loves Head Start’s embrace of culture, recalling one visit to a center where he could smell staff cooking stew chicken, a traditional Caribbean dish.
“I’ve been to dozens of schools throughout the district, and you don’t get that home-cooked meal,” Worrell said. “[The state is] stepping up and doing the best we can with what we have.”
At the Action for Boston Community Development’s Head Start and Early Head Start center in Dorchester, the children of Classroom 7 arrived one Monday morning and dove into bins of magnetic tiles before their teachers, Paola Polanco and Leolina Rasundar Chinnappa, served breakfast. Acosta dropped off her 4-year-old daughter, Violeta, before reporting to her teaching position at the center, where several other Head Start parents also work.
“It’s important for all Head Start parents to have the opportunity to give their child an experience in a learning environment before they actually start kindergarten,” Acosta said.
Beyond providing early education and care to children of low-income families, from birth to age 5, the program helps them access other resources, including mental health services, SNAP benefits, homelessness assistance, and employment opportunities.
It also serves as daycare for parents who might not be able to afford it, while they’re at work.
Research has shown the importance of preschool in a child’s development with one 2023 study, focused on Boston public preschools, finding that it improves student behavior and increases the likelihood of high school graduation and college enrollment.
For Rickencia Clerveaux and Christopher Mclean, the Dorchester Head Start center is the only place they feel comfortable sending their 3-year-old son, Shontz, who is on the autism spectrum. Shontz’s stimming — repetitive movements that stimulate the senses — has reduced, and his speech has improved since he joined the center in 2024, Clerveaux said.
His parents say he’s also come out of his shell. Mclean now drops his son off and gets a simple “bye” as Shontz joins his classmates, he said.
He and Clerveaux said they appreciate the specialized attention Shontz can receive from teachers, such as when staff identified that Shontz might have hearing issues. His parents were able to follow up with their doctor and get Shontz to have surgery to improve his hearing.
“It’s a safe net for parents,” Clerveaux said. “There’s so many ways that him being here helps him grow better.”
Without Head Start, Clerveaux said a lot of pressure would be put on parents to find care for their children, “knowing that they’re already struggling or not getting the ends to meet.”
“That’s a burden for everybody in the community,” she said. “If there’s no funding, there’s no daycare and parents cannot work.”
Lauren Albano can be reached at lauren.albano@globe.com. Follow her on X @LaurenAlbano_.
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