This report – written by Elisabeth Rodman of the Blue Cross Blue Shield of Massachusetts Foundation – explains how the Commonwealth of Massachusetts chose to implement the Affordable Care Act (ACA) and the resulting changes to health programs, policies, and operations. This report serves as a follow up to Re-Forming Reform: What the Patient Protection and Affordable Care Act Means for Massachusetts, and describes the changes to the state’s subsidized coverage options, eligibility and enrollment policies and procedures, private insurance market, and payment reform initiatives that will result from ACA implementation.