Reports & Publications

Massachusetts: The model for national health care reform

Massachusetts led the nation in 2006 with a comprehensive health care reform law and the establishment of a new Marketplace: the Massachusetts Health Connector, designed to make affordable health insurance available to more people. Today over 250,000 Massachusetts residents have health insurance through the Health Connector, and our state has the highest rate of health insurance coverage in the nation. National health reform builds upon the successful example set by Massachusetts. As a result, individuals, families, and small businesses who go to the Health Connector can find even more options, enhanced benefits, and savings.

In This Section:

 

The Law

Massachusetts Health Care Reform became law on April 12, 2006. It is Massachusetts’ plan to reduce the number of people who have no health insurance.  It also works to improve the cost and quality of health care.Visit the “Rules & Regulations’ page to read the entire law.

 

Facts and Figures

Get the latest summary of the key achievements of Massachusetts Health Care Reform.

Progress Reports

Each year, the Health Connector publishes a booklet highlighting what we’ve accomplished and who we’ve helped.

NEW Massachusetts Medicaid Buy-in Study

Report on the feasibility of establishing a small employer premium sharing plan for participation in the MassHealth program.

Download the Report →

 

Ensuring Students Get Coverage

Every full-time and part-time student enrolled in an institution of higher learning in Massachusetts must participate in a Student Health Insurance Program (SHIP) or in a health benefit plan with comparable coverage.

Click here to learn more about the Student Health Insurance Program (SHIP) →

 

Market-wide Risk Adjustment

The Health Connector is responsible for administering the market-wide risk adjustment program for the small and non-group merged market for plan years effective January 1, 2014 onwards.

The Massachusetts-specific approach to risk adjustment is detailed in the Commonwealth of Massachusetts Notice of Benefit and Payment Parameters 2016 (PDF) released March 27, 2015.

The Technical specifications workbook (MS Excel) is also publicly available:

Risk Adjustment Data Validation for 2015 Benefit Year

Consistent with the federal approach, the Health Connector determined not to conduct risk adjustment data validation (RADV) for the 2014 benefit year, but is proceeding with RADV for the 2015 benefit year.  The Health Connector will proceed with its approach, as described in the 2016 Payment Notice, to use a single-level validation approach to RADV for this initial year.  Under this approach, an auditor retained by the Health Connector will validate demographic and diagnostic information for a representative sample of enrollees selected from each issuer.  Consistent with the federal approach, results from the RADV audit will not lead to adjustments in fund transfers for the 2015 benefit year.  The Connector is assessing whether for the 2016 benefit year to conduct a single-level or two-level RADV program in anticipation of transitioning the risk adjustment program to the federal system for the 2017 benefit year.

Previous Years’ Publications:

Data on the Individual Mandate

November 2017 — The Massachusetts Individual Mandate: Design, Administration, and Results

July 2016 —The Blue Cross Blue Shield of Massachusetts Foundation published two reports about the remaining uninsured in Massachusetts co-authored by the Health Connector and the University of Massachusetts Medical School:

We worked with the Massachusetts Department of Revenue to review enforcement of the requirement to enroll in health coverage.

 

Health Care in Massachusetts: Key Indicators

The Massachusetts Division of Health Care Finance and Policy produces a quarterly analysis of data related to Massachusetts Health Care Reform.  Go to its site, scroll down to “Key Indicators Report.”
Go to the Massachusetts Division of Health Care Finance and Policy’s publications page →