The Executive Office of Health and Human Services (EOHHS) is the largest executive agency in state government and oversees expenditures of approximately $19.4 billion annually. EOHHS has approximately 22,000 employees and serves approximately 2 million clients. Section 1115 of the Social Security Act gives the Centers for Medicare and Medicaid Services (CMS) the authority to approve “non-traditional,” pilot, or demonstration projects that are likely to assist in promoting the objectives of the Medicaid program. The purpose of these “1115 waivers” is to give states additional flexibility to design and improve their Medicaid programs, and to demonstrate and evaluate state-specific policy approaches to better serve the Medicaid population. Massachusetts has operated an 1115 waiver since 1997; the most recent demonstration was authorized in 2022 and expires in 2027. Building upon previous demonstrations, under its current 1115 demonstration, MassHealth continues the Accountable Care Organi...