Massachusetts has been exemplary in developing health insurance coverage policies to cover its residents. By 2019, the state’s uninsurance rate was 3.0 percent, the lowest rate in the nation, representing about 204,000 uninsured residents. While the state’s overall uninsured rate at a given point in time is low, more than twice as many people - 503,000, or 7.3 percent of the population - experienced a gap in coverage over the previous twelve months. And importantly, not all groups benefit equally. People who are Black or Hispanic, or who have lower incomes, experience significantly higher rates of uninsurance than the state population overall. As a result, these groups are more likely to face access barriers and financial insecurity associated with being uninsured.

The purpose of this report is to begin charting a course toward closing the coverage gaps in Massachusetts, with a particular focus on creating a more racially and ethnically equitable system of coverage. The report and accompanying infographics describe the people in Massachusetts without health insurance and the barriers to coverage they face, including affordability, administrative complexity, and immigration, language, and cultural barriers. It then proposes a menu of policy options that address the specific circumstances in Massachusetts. The proposed options are meant to inform a statewide conversation about the best approaches to closing the remaining coverage gaps in Massachusetts and removing structural barriers that result in racial and ethnic disparities in health insurance coverage.

Behind the Data: Voices of the Uninsured
The Foundation recently released a 3-minute video featuring four Massachusetts residents who describe their experiences without health insurance. The video is also available with English subtitles and Spanish subtitles (con subtitulos en Español).

Click here to view

This issue brief aims to educate stakeholders and policymakers about an upcoming federal policy change that could impact coverage for many MassHealth members. Like all states, Massachusetts received enhanced federal Medicaid funding under the Families First Coronavirus Response Act (FFCRA), the first major federal stimulus package passed by Congress in response to the COVID-19 crisis in 2020. As a condition of receiving these funds, Massachusetts was required to maintain continuous coverage in MassHealth during the federal COVID-19 public health emergency. In December 2022, Congress passed the Consolidated Appropriations Act, 2023 which established March 31, 2023 as the end date of the continuous coverage requirement.

Since the federal continuous coverage requirement will expire at the end of March, MassHealth is preparing to redetermine eligibility for all members starting April 1, 2023. As MassHealth begins to redetermine eligibility for a considerable volume of members, there is a risk that some individuals who remain eligible for coverage could become uninsured. This issue brief includes a summary of MassHealth’s eligibility and enrollment approach for when it resumes normal eligibility and redetermination processes and describes strategies that MassHealth and other stakeholders are taking to ensure that people who remain eligible stay covered.

This UPDATED (October 2022) edition of the MassHealth: The Basics chart pack provides new data on MassHealth enrollment and spending from the most recent state fiscal years available. The chart pack also features a high-level overview and status update on the state’s delivery system reform efforts, including a summary of the key elements of MassHealth’s latest 1115 demonstration waiver extension that was approved by the Centers for Medicare and Medicaid Services on September 28, 2022.

The chart pack provides comprehensive yet accessible data points and program updates to help policymakers, administrators, advocates, and academics better understand the complex MassHealth program. It is made available in PDF and PowerPoint formats to facilitate its use in presentations.

MMPI recently hosted a webinar to review facts and data about MassHealth eligibility, costs, and recent reforms from the latest edition of MassHealth: The Basics. Click here to access a recording of this webinar and a copy of the webinar slides.

Massachusetts, with support from the federal government, has implemented several policy and programmatic changes intended to promote continued access to health care services and health insurance coverage during the COVID-19 public health emergency. This table serves as a centralized resource that documents and describes the policy, regulatory, and administrative actions pertaining to MassHealth, Health Connector programs, and the Health Safety Net. This resource is intended to be used by advocates, enrollment assisters, and other stakeholders to assist consumers in identifying options to protect their access to coverage and health care services. Since policies and programs are changing frequently in the current environment, this resource will be regularly updated.

Stay up to date on changes to this resource by signing up for our email list.

An updated version of this issue brief is now available here.

This issue brief aims to educate stakeholders and policymakers about an upcoming federal policy change that could impact coverage for many MassHealth members.  Like all states, Massachusetts received enhanced federal Medicaid funding under the Families First Coronavirus Response Act (FFCRA), the first major federal stimulus package passed by Congress in response to the COVID-19 crisis in 2020. As a condition of receiving these funds, Massachusetts is required to maintain continuous coverage in MassHealth during the federal COVID-19 public health emergency. When the continuous coverage requirement expires at the end of the month in which the public health emergency ends – which is currently slated for July 14, 2022 – MassHealth will resume its standard renewal, or “redetermination,” processes. As MassHealth begins to redetermine eligibility for a considerable volume of its members, there is a high risk that some individu­als who remain eligible will experience a loss in coverage. This brief includes a summary of MassHealth’s eligibility and enrollment approach for when it resumes normal eligibility and redetermination processes and describes additional strategies that MassHealth and other stakeholders can take to ensure that people who remain eligible stay covered.

This report provides an analysis of the impacts of the enhanced premium subsidies for purchasing health insurance through the Marketplace, or Health Connector in Massachusetts, that the American Rescue Plan Act (ARPA) temporarily authorized through 2022. While Massachusetts already provided additional state-based financial assistance to many marketplace enrollees prior to ARPA, ARPA enhanced subsidies for some individuals and introduced a new cap on the amount anyone purchasing through the Marketplace has to pay in premiums, effectively expanding eligibility for subsidies to purchase health insurance.

The Build Back Better Act that passed the House of Representatives and is currently stalled in the Senate would extend these subsidies through 2025. In this brief, we evaluate the coverage and cost effects of extending the enhanced subsidies in Massachusetts in 2023. The estimates suggest that, if extended, the enhanced subsidies would:

• reduce the number of people who are uninsured in Massachusetts by 8,000 people;
• reduce household spending on premiums for people who purchase subsidized coverage through the Health Connector; and
• save the state an estimated $133 million in spending on ConnectorCare subsidies in 2023.

The report provides a more detailed look at each of these effects and is intended to be a resource for health care advocates, policymakers, and other stakeholders to understand the impact of these subsidies expiring.

This primer serves as a foundational resource to broaden the collective understanding of racial and ethnic health inequities and disparities in the Commonwealth as part of our new focus area of Structural Racism and Racial Inequities in Health. The primer is intended to support discussion about how our health care system and other systems that impact health enhance or undermine health, and to facilitate the development of solutions to strengthen those systems to serve all Massachusetts residents.

The primer presents a data-informed reflection of the racial and ethnic health inequities and disparities Massachusetts residents confront today. It offers a basis for further discussion and action, including to evolve and improve the data resources that shed light on racism and racial inequities in Massachusetts’ social and health care systems. The Foundation’s work in this focus area will aim to identify and elevate health care policies and practices that will advance health equity and reduce health disparities in the Commonwealth.

To the extent possible in the confines of a data-focused report, the primer acknowledges critical context about the historical and structural contributors to the racial and ethnic health inequities and disparities that exist today. Data limitations and gaps are noted throughout, identifying where new or improved data is needed to provide a comprehensive, cohesive, and actionable set of data to support the Commonwealth’s health equity goals.

In response to the health and economic damage caused by the COVID-19 pandemic, Congress passed the American Rescue Plan Act (ARPA) in March 2021, which makes $1.9 trillion available to individuals, states and territories, counties, cities, community organizations, educational institutions, and other entities. Some funds are intended to shore up or even expand programs and agencies that have been depleted during the pandemic, while other funds are designated or available to create new programs. ARPA contains many health-related provisions, with particular focus on behavioral health services (inclusive of mental health and substance use care), the health care workforce, and programs that make health insurance coverage and health care available to more people. This summary focuses on the key components of ARPA that will affect health care in Massachusetts.

This five-part series of issue briefs describes MassHealth’s impact on the health and finances of its members, families, and communities, as well as on the wide variety of stakeholders and sectors outside of the traditional health care realm that benefit from the program, including:

• the Commonwealth’s schools and school‐aged children, teens, and young adults;
• the state’s economy and businesses, including how MassHealth supports working families, reduces uncompensated care costs, and draws federal funds into the state;
• the behavioral health care system, addressing how MassHealth provides coverage, access, and delivery of services across the full behavioral health care continuum; and
• justice-involved persons, describing how MassHealth supports re-entry into the community.

Key findings from this series were featured at a Foundation virtual event on Wednesday, June 30^th from 2:00-4:00 pm. Click here to view event materials.

This resource highlights the most recent monthly enrollment data available for MassHealth and ConnectorCare — the two most prominent sources of publicly financed health insurance in Massachusetts. The compiled data and highlighted trends described in this resource are intended to help policymakers, health care stakeholders, and others track how enrollment in these programs has changed since the COVID-19 pandemic began affecting public health and the economy of the Commonwealth. This resource will be updated regularly with the latest enrollment data as it becomes available.

Stay up to date on the latest updates to this enrollment tracker by signing up for our email list.

California v. Texas, a case currently before the U.S. Supreme Court, seeks to overturn the Affordable Care Act (ACA). The court is expected to begin hearing arguments on this case on November 10, 2020. A final ruling that overturns the ACA would have widespread implications, affecting every state in the nation.

This brief and companion infographic describe what’s at stake for Massachusetts if the court were to overturn the ACA — focusing on what it could mean for the state’s health insurance coverage rates and federal funding. This analysis is based on two scenarios: 1) where the ACA is overturned in its entirety and the state is not able to reestablish the subsidized coverage programs created by the state’s 2006 health reform and 2) where the ACA is overturned, but the state is able to reestablish its 2006 coverage programs.

The estimates described in this brief are generated from a model developed by the Urban Institute, which was used for a similar analysis released by the Foundation in December 2019. This new analysis uses state-level 2019 and 2020 cost and coverage data from MassHealth, the Health Connector, and the Center for Health Information and Analysis. The updated data used for this analysis captures many of the changes to the health insurance coverage landscape in Massachusetts as a result of COVID-19 and the associated economic downturn.

The revised federal public charge rule – which was finalized in August 2019 and took effect in Massachusetts in February 2020 – makes it harder for certain low- and moderate-income immigrants to obtain green cards or visas if they have applied for or enrolled in public benefits such as MassHealth or the Supplemental Nutritional Assistance Program (SNAP). This report describes the expected effects of the revised federal public charge rule on MassHealth and SNAP enrollment, and its downstream effects on the health of Massachusetts residents, health care providers, and the state’s economy.

This report updates and builds upon a November 2018 publication, The Proposed Public Charge Rule: An Overview and Implications in Massachusetts, which featured a similar analysis based on the proposed public charge rule. This current report analyzes the impact of the final rule, uses more recent data as the basis for its estimates, and updates the methodology based on new information. The estimates in this report do not account for strategies that are taking place within Massachusetts to try to mitigate the impact of public charge on enrollment in MassHealth - including intensive outreach and education in immigrant communities.

Texas v. United States, a case currently before the U.S. Court of Appeals for the Fifth Circuit, seeks to overturn the Affordable Care Act (ACA). The court’s decision in the case could be announced any day and the case may ultimately be decided by the Supreme Court. A final ruling that overturns the ACA would have widespread implications, affecting every state in the nation.

This brief describes the implications of repeal for Massachusetts — focusing on what it could mean for the state’s health insurance coverage rates and federal funding, and what conditions would be necessary to prevent a significant erosion of Massachusetts’ coverage gains if the courts were to overturn the ACA. Two main scenarios are described: 1) where the ACA is overturned in its entirety and the state is not able to reestablish the subsidized coverage programs created by the state’s 2006 health reform and 2) where the ACA is overturned, but the state is able to reestablish its 2006 coverage programs.

The estimates described in this brief were generated from a model developed by the Urban Institute using state-level 2019 cost and coverage data from MassHealth, the Massachusetts Health Connector, and the Center for Health Information and Analysis.

This brief and accompanying set of tables serve as an update to previously released reports on the geography of uninsurance in Massachusetts. Relying on newly released data for 2013-2017 from the American Community Survey (ACS), this brief uses three measures of uninsurance – uninsurance rate, number of uninsured, and concentration of uninsured – to identify high-uninsurance communities in the state. This brief also provides new information on socioeconomic characteristics of high-uninsurance communities and their uninsured residents to further inform strategies for targeted outreach efforts. Among other key findings, by looking at the concentration of uninsured residents (i.e., the number of uninsured per square mile of land area) to identify high-uninsurance communities, we find that the uninsured are concentrated in a relatively small number of communities, primarily in and around Boston.

Included with this release is a set of detailed tables available for download that provide estimates of the rate and number of uninsured for all persons, children (ages 0-18), and adults (ages 19-64), by various geographic units, including Congressional districts, counties, cities and towns, and census tracts.

This collection of materials is the latest in a series by the Urban Institute summarizing the findings from the 2018 Massachusetts Health Reform Survey (MHRS). The Foundation began conducting the MHRS in fall 2006 to support the evaluation of Massachusetts’ 2006 health care reform bill. The survey has been fielded periodically since 2006 – most recently in spring 2018 – to monitor key measures pertaining to health insurance coverage and health care access and affordability among non-elderly adults (ages 19-64) in Massachusetts. For the first time in 2018, the MHRS included several questions pertaining to access to care for mental health (MH) and substance use disorder (SUD) services.

The 2018 MHRS highlights the state’s ongoing success at maintaining near-universal health insurance coverage since the passage of Massachusetts’ 2006 health care reform law. However, the survey’s core measures demonstrate that opportunities for improvements in access to and affordability of health care for the state’s residents remain and the new questions on MH/SUDs highlight the significant barriers to care and gaps in access to care faced by those seeking MH/SUD services. The survey findings are a reminder that the goals of health care reform are not fully achieved by simply reducing the number of people who are uninsured. New strategies are needed to improve access to care and reduce the burden of health care costs for Massachusetts adults and their families, particularly for the most vulnerable.

Findings from the 2018 MHRS were featured at a Foundation event held on December 11, 2018. Click here to learn more about the event.

This year’s results are presented in a variety of publications including:

This brief describes the potential impact in Massachusetts of a proposed rule, released by the Department of Homeland Security in October 2018, to change the process by which it determines whether an immigrant is inadmissible to the United States or unable to adjust status because the person is likely to become a “public charge.” The proposed Public Charge Rule would mark a significant shift from current policy by defining a “public charge” as a noncitizen who receives one or more public benefits. This brief also provides an estimate of the scope of immigrants in Massachusetts who may be impacted by the proposed rule and what effect that could subsequently have, both directly and as a result of the “chilling effect,” on enrollment in particular benefit programs, including MassHeath and the Children’s Health Insurance Program (CHIP).

This brief frames the key issues and potential impacts to Massachusetts consumers that may result from implementation of the federal proposed rule to expand the availability of Association Health Plans (AHPs). This brief:

• Describes the ways in which allowing AHPs to operate according to the proposed rule could impact the scope of benefits, provider networks, and consumer protections available to consumers in plans covered through this arrangement;
• Explains technical topics such as risk segmentation and rating rules and why they are important in considering the impacts of the proposed AHP rule on consumer access to health coverage; and
• Provides policymakers with options the Commonwealth could consider to protect consumers in response to the federal AHP proposal.

This brief provides an overview of the steps that Massachusetts has taken to establish a functioning insurance market that provides consumers with meaningful access to health coverage. It includes a review of statutory and regulatory provisions in place today, and provides context for key health reform initiatives that have occurred over the past 30+ years. This brief is structured around four key components of a functioning market for health coverage:

1. Encouraging or requiring coverage of a comprehensive set of benefits and services;
2. Ensuring fair competition among insurance carriers;
3. Providing access to coverage, particularly for low- and middle-income residents; and
4. Instituting mechanisms to protect consumers.

The policies and provisions described in this brief have played an important role in the evolution of the Massachusetts market, helping the state achieve near-universal coverage, enabling most Massachusetts employers to offer comprehensive coverage to their employees, establishing a competitive market for health coverage, and protecting consumers.

Federal authorization for the Children’s Health Insurance Program (CHIP) expired on September 30, 2017. Senators Orrin Hatch (R-UT) and Ron Wyden (D-OR) have filed a bill to extend CHIP for five years, but Congress did not act quickly enough to prevent the current authorization from expiring. Unspent federal CHIP funds may be carried over into the next fiscal year and Massachusetts’s current allotment of federal CHIP funds should allow the state to continue to use CHIP funds for benefits until early 2018. However, we have now entered a policy limbo in which states are hopeful for reauthorization but must also determine other coverage options for children if funds run out.

As follow up to the Foundation’s June report, The Importance of CHIP Reauthorization for Massachusetts, this brief provides an update on the status of federal reauthorization for CHIP and a summary of its potential impact on the program in Massachusetts.

This chart pack provides an overview of the Senate-proposed Better Care Reconciliation Act of 2017, highlighting some of its key provisions, particularly as they relate to Medicaid. Developed by Manatt Health, this chart pack was commissioned by the Blue Cross Blue Shield of Massachusetts Foundation for the Massachusetts Coalition for Coverage and Care.