EC101 Massachusetts

Health Insurance

Health & Wellbeing

Services that address the development, physical health, and mental health of young children, their caregivers, and their relational wellbeing

Publicly Provided

The Massachusetts Medicaid program (MassHealth) is a health insurance plan for the nearly one-fifth of Massachusetts residents with low or medium income levels. Any child born to parents eligible for MassHealth is automatically eligible for up to one year.

Program Snapshot: MassHealth

  • LOCATION

    Massachusetts (statewide)

  • UTILIZATION

    700,000 children in Massachusetts

  • ANNUAL OR ONE-TIME?

    Annually Renewed + One-time COVID- specific supplemental funding 

  • FUNDING SOURCE

    Title XIX of the Social Security Act, 1965

    Many other federal acts supporting MassHealth are transitory and not sustainable, such as the recent Families First Coronavirus Response Act (FFCRA) and American Rescue Plan Act, which brought in additional funding for COVID relief.

  • FUNDING AMOUNT

    Breakdown of FY2022 Funding:

    • State tax revenues: $33.2 billion
    • Federal revenues: $14.1 billion
    • Fees (premiums paid by members, rebates by pharmaceutical companies): $4.1 billion
    • Lottery: $2.4 billion

Learn more about MassHealth
Health & Wellbeing
Ages
Birth - 5 years
Usage

Universal

Services that are intended to be utilized by all children and/or families
Geography
Statewide
Professionals
MassHealth
Settings
Doctor Offices, Clinics, Specialist Offices, Pharmacies
Oversight, Guidance, and Regulation
United States Department of Health and Human Services
MA Executive Office of Health and Human Services
Equity Considerations
In Massachusetts there are disparate utilization rates of MassHealth based on race. People of color, particularly Black individuals and families, are more likely to be on MassHealth compared to other individuals and families. Further, reimbursement rates for MassHealth tend to be low, which can limit access to care for enrollees.
Health & Wellbeing
Ages
Birth - 5 years
Usage

Universal

Services that are intended to be utilized by all children and/or families
Geography
Statewide
Professionals
Private Insurers
Settings
Doctor Offices, Clinics, Specialist Offices, Pharmacies
Oversight, Guidance and Regulation
Executive Office of Housing and Economic Development, Division of Insurance

Private Health Insurance

Private provider insurance is health insurance coverage that is offered by a private entity, rather than the state or federal government.

Equity Considerations
This type of insurance is typically provided through an employer, which can limit access for those who are unemployed, between jobs, or working in jobs that don’t offer comprehensive benefits. Additionally, there are barriers to access in the form of copays and deductibles, which can limit affordability, as well as restrictions on in-network or specialty care, depending on the plan and provider.
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