MassHealth Director Mike Levine will step down in June to take a top city government post in San Francisco, exiting state government just as the sprawling health insurance program confronts major challenges tied to looming federal funding cuts and a high-stakes waiver renewal.
Levine told staff Tuesday that his last day leading the roughly $23 billion program will be June 12, calling his departure “bittersweet” after more than a decade at the agency.
“This summer, my family and I will be relocating to the west coast,” Levine wrote in an email to employees, adding that his priority over the coming weeks will be “to ensure a smooth transition” and that “our work is too important” to lose momentum.
On Wednesday, San Francisco Mayor Daniel Lurie announced Levine’s appointment to lead the city’s Department of Homelessness and Supportive Housing, citing his experience overseeing one of the nation’s largest Medicaid programs and integrating health care with housing and behavioral health services.
Levine’s departure creates a leadership opening at a consequential moment for MassHealth, which covers nearly 2 million residents and accounts for more than one-third of the state budget.
State officials are preparing for impacts from a 2025 federal law that is expected to reduce Medicaid funding and tighten eligibility rules for some program enrollees. Massachusetts could lose about $3.5 billion in federal support once the changes are fully implemented, with policymakers warning that coverage losses could reach up to 300,000 and strain hospitals and community providers already under financial pressure.
MassHealth is also preparing to negotiate an extension of its Section 1115 demonstration waiver, a critical accord with the federal government that shapes how the state delivers and pays for care. The current waiver expires at the end of 2027, and officials are in the process of planning their request for a waiver renewal.
The waiver has been central to the state’s shift toward accountable care organizations, expanded behavioral health services, and coverage of housing and nutrition supports. It has also generated just over $500 million in savings and is viewed by state officials as a key tool for maintaining low uninsured rates and controlling costs.
These negotiations are expected to unfold alongside implementation of new, more restrictive federal Medicaid requirements, including more frequent eligibility checks and potential work or community engagement rules for some enrollees.
Levine began at MassHealth in 2016 as a strategy manager, rising in the agency until he was appointed to lead it in 2023, according to his LinkedIn.
In a statement, Gov. Maura Healey said Levine’s leadership “has been outstanding” pointing to his work steering the program through the COVID-19 pandemic and “major federal policy shifts.”
Health and Human Services Secretary Kiame Mahaniah highlighted his role in an exhaustive eligibility redetermination process and expansion of community behavioral health centers.
During his tenure, Levine said in his email to staff, MassHealth implemented a primary care payment model affecting roughly 1,000 practices, expanded behavioral health infrastructure that contributed to a reduction in psychiatric emergency department boarding, and completed a large-scale post-pandemic eligibility review.
Levine wrote that when he joined MassHealth more than a decade ago he was “a newlywed with no kids and little clue what it meant to work in Medicaid,” and said the agency had become his “extended family.” He plans to remain in the office full-time through his departure date and work with staff through the transition.
In San Francisco, Levine will take on a system grappling with persistent homelessness and behavioral health needs. Lurie said Levine’s background connecting health care and social services would help the city “build on our momentum” addressing those challenges.
Levine said in the press release from Lurie’s office that his experience has shown “homelessness is more than a housing issue,” emphasizing the need to align health care, addiction treatment and social supports.
With federal policy changes still being interpreted and the next waiver cycle approaching, the incoming director will inherit a program facing immediate fiscal pressure and long-term uncertainty about its funding and design.
[Gintautas Dumcius contributed reporting.]
Sam Drysdale is a reporter for State House News Service and State Affairs Pro. Reach her at sdrysdale@statehousenews.com.
