MassHealth 101

July 31, 2019

MassHealth, the name for Medicaid and the Children’s Health Insurance Programs in Massachusetts, provides critical health insurance coverage to millions of Massachusetts residents. But what is it? What does it cover? Who is eligible? How much does it cost? A new MassHealth: The Basics – Facts and Trends report prepared by Commonwealth Medicine, UMass Chan Medical School for the Massachusetts Medicaid Policy Institute at the Blue Cross Blue Shield of Massachusetts Foundation answers these questions with a trove of facts, trends, and informative infographics.  

The report, available on the Foundation website, reviews the fundamentals of MassHealth, shows how the program has changed over time, and describes impactful new MassHealth initiatives. Here are a few of the major themes and key takeaways:

MassHealth Enrollment

The program provides coverage to more than 1.8 million members – more than a quarter of Massachusetts residents. This high level of enrollment has remained relatively stable over the past four years and helped contribute to Massachusetts’ high insured rate (the percentage of individuals covered by some form of health insurance.)

Coverage is particularly important to the low-income workforce. MassHealth provides coverage to almost 100,000 sales and food services workers across Massachusetts. Additionally, the program provides critical coverage to vulnerable populations; more than 40% of all children and people with disabilities in Massachusetts were covered by MassHealth in 2017. 

MassHealth Spending

MassHealth spent approximately $15 billion in 2017. The federal government reimburses Massachusetts for 50% to 93% of MassHealth costs, depending on the population served. MassHealth is the main source of federal revenues to Massachusetts. Approximately 85% of all budgeted federal revenue for Massachusetts is generated by Medicaid, the Children’s Health Insurance Program, or ConnectorCare (coverage offered by the Massachusetts Health Connector.)1

Spending growth has moderated in recent years; spending increased around 4% between 2016 and 2019 compared to double-digit increases from 2013 to 2016. Cost increases on prescription drugs and home- and community-based long-term services and supports are sectors to watch.

MassHealth spending is also a critical source of revenue for a wide range of health care providers. For example, more than half of nursing facilities and community health centers’ revenue was from MassHealth in 2015.

MassHealth Innovations

Massachusetts has been hit hard by the substance use disorder epidemic; more than 2,100 individuals died from an opioid-related overdose in 2017.2  To help combat this crisis, MassHealth has launched several initiatives to help members including increasing outpatient, residential inpatient, and community services, as well as supporting the use of recovery support navigators and coaches. MassHealth will also provide technical assistance to primary care providers to help increase the use of Medication Assisted Treatment (MAT), an evidence-based intervention.

Improving health outcomes while managing rising costs is the aim of a MassHealth initiative that delivers care through Accountable Care Organizations (ACOs.) ACOs are groups of doctors, hospitals, and other health care providers that work together to deliver better care to members, improve population health, and control costs.3 There are approximately 890,000 MassHealth members enrolled in ACOs as of Spring 2019.

Social determinants of health is another area of focus for MassHealth, which has tasked ACOs to coordinate care and connect members with social services. In January 2020, MassHealth plans to launch the Flexible Services Program for eligible MassHealth members enrolled in an ACO. The Flexible Services Program will offer services like housing application assistance and home-delivered meals.