This is it – no more short term extensions. This morning federal CMS officials and the Commonwealth reached agreement on a 3-year MassHealth waiver. You can read the official documents here (big pdf).

According to EOHHS, the agreement includes all the elements announced in late September as part of the agreement in principle. Here are the key points from the state’s notice to stakeholders:

Key features of the agreement include:

1. The total spending authority granted by the federal government is approximately $21.2 billion, which is $4.3 billion more than in the last three year term.

2. All eligibility and benefit levels are preserved. The agreement secures the ability to claim federal financial participation (FFP) to match state spending on all programs as currently designed, including Commonwealth Care at 300% FPL.

3. The agreement allows the state to meet all of its health care obligations for Fiscal Year 2009. In Fiscal Year 2009, the state will be able to claim $150 million for programs for which it was unable to claim matching funds for in Fiscal Year 2008.

4. The agreement expands the Patrick Administration’s authority to bill for programs in the Safety Net Care Pool by $1 billion over the current waiver period. The Safety Net Care Pool (SNCP) represents authority for federal reimbursement for Commonwealth Care payments, Health Safety Net (the “free care pool”) spending and hospital supplemental payments.

5. A flexible Cap in the Safety Net Care Pool. The federal government has proposed a three-year cumulative cap on Safety Net Care Pool expenditures, instead of the current annual cap. This flexibility allows the state to meet all of its commitments for Fiscal Year 2009 and to plan ahead to meet all Fiscal Year 2010 and Fiscal Year 2011 commitments.

We congratulate all of the Office of Medicaid and EOHHS staff who have been working very long and very hard to get to this point. The agreement allows health reform to continue with federal support through June 2011.

We haven’t read through the documents yet, and look forward to the always informative analysis by the Mass Medicaid Policy Institute, due soon.