Reports & Publications - Massachusetts Health Connector

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. Over 400,000 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.

Publications

Health Care Reform in Massachusetts: 20 Years of Impact

April 2026

In 2006, Massachusetts passed a landmark health care law known as Chapter 58. Two decades later, this bipartisan effort has transformed how residents access and pay for medical care. The state now boasts the highest rate of health insurance coverage in the country, with nearly 98 percent of residents insured.

This massive increase in coverage has directly improved public health. Massachusetts currently ranks first in the nation for preventing premature deaths from treatable causes. The state also maintains the lowest infant mortality rates and the highest childhood vaccination rates.

To make this possible, Massachusetts prioritized affordability. Programs like ConnectorCare offer state-funded subsidies that lower the cost of premiums and out-of-pocket expenses for individuals and families. Because of these strong support systems, residents face significantly lower rates of medical debt than the rest of the United States.

The success of Chapter 58 eventually served as the blueprint for the national Affordable Care Act. Today, Massachusetts continues to adapt its policies to protect vulnerable populations and ensure health care remains accessible and affordable for everyone.

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All Publications

Title	Create Date	Excerpt
Student Health Insurance Program Report for Academic Year 2024-2025	05/18/2026	March 2026—The Student Health Insurance Program (SHIP) Report for Academic Year 2024–2025 explains how student health coverage is provided across Massachusetts. In the reported year, 92 institutions offered SHIPs, covering over 117,000 students, while 394,697 students overall were subject to the SHIP requirement.
Health Care Reform in Massachusetts: 20 Years of Impact	03/25/2026	April 2026 - Twenty years after the Massachusetts Legislature passed and Governor Mitt Romney signed Chapter 58 of the Acts of 2006, "An Act Providing Access to Affordable, Quality, Accountable Health Care," Massachusetts continues to lead the nation with the highest rate of health insurance coverage. Chapter 58 was the result of years of analysis, strategy development, and collaboration among state leaders in the Legislature, the Governor’s office and the Executive Branch, consumer advocates, business leaders, health care providers and payers, and other stakeholders to establish a groundbreaking, bipartisan approach to near universal health coverage.
Health Care Sharing Ministries Reporting to the Massachusetts Health Connector in 2024	03/10/2026	March 2026—A summary of information reported to the Health Connector by health arrangements provided by an established religious organization seeking minimum creditable coverage status for 2024.
Connected to Coverage: Member Transitions to the Health Connector During the Medicaid Redeterminations Process	07/31/2025	July 2025—In April 2023, after three years of COVID-era federal Public Health Emergency coverage protections, the Health Connector began welcoming tens of thousands of newly-eligible residents. These residents came to the Health Connector seeking access to affordable health care coverage, a process that ran through 2024 as MassHealth redetermined the eligibility of all 2.4 million of its members. In Massachusetts, the Medicaid and CHIP programs are known together as MassHealth.
ConnectorCare Expansion Pilot Annual Report to the Legislature	07/01/2025	July 2025—The ConnectorCare Expansion Pilot Annual Report highlights the significant impact of extending health coverage in Massachusetts to individuals earning up to 500% of the federal poverty level. Since the pilot began in 2024, over 115,000 individuals have gained more affordable insurance, with 63,000 actively enrolled as of mid-2025. The program offers benefits such as lower premiums, no deductibles, and reduced co-pays, helping residents access necessary care, including preventive services and medications for chronic conditions.
2024 Report to the Massachusetts Legislature: Activities and Accomplishments of the Massachusetts Marketplace	05/22/2025	May 2025—The 2024 Report to the Massachusetts Legislature highlights a 40 percent increase in enrollment, reaching more than 360,000 members. This growth includes a rise in ConnectorCare enrollment, which expanded eligibility to individuals earning up to 500 percent of the federal poverty level. Additionally, thanks to effective outreach and community support, over 145,000 residents transitioned to new coverage after losing MassHealth during the unwinding of the Medicaid continuous enrollment provision.
Student Health Insurance Program Report for Academic Year 2023-2024	05/06/2025	March 2025—The Student Health Insurance Program (SHIP) Report for Academic Year 2023-2024 details how health insurance is provided to students in Massachusetts. In the reported year, a total of 91 institutions offered SHIPs and covered over 120,000 students. The program remains a cost-effective and comprehensive coverage option for students in Massachusetts.
Health Care Sharing Ministries Reporting to the Massachusetts Health Connector in 2022 and 2023	05/01/2025	March 2024—A summary of information reported to the Health Connector by health arrangements provided by an established religious organization seeking minimum creditable coverage status for 2022 and 2023.
ConnectorCare Expansion Pilot Report	08/26/2024	August 2024 - The ConnectorCare pilot expansion in Massachusetts has provided over 51,000 residents with access to more affordable health insurance, thanks to increased income eligibility limits from 300 percent to 500 percent of the federal poverty level. This initiative, part of the Fiscal Year 2024 state budget, has resulted in significant cost savings for members, with some saving over $150 monthly on premiums.
Massachusetts Health Connector 2022 Open Enrollment Period: Final Enrollment Results	06/08/2022	June 2022—Building on the Commonwealth’s state health reform efforts and Affordable Care Act’s success, the American Rescue Plan (ARP) has been instrumental in providing premium relief to state residents, driving 253,000 individuals to enroll with the Health Connector during Open Enrollment (OE) for 2022 coverage. Massachusetts’s bedrock of affordability meant the state had a higher coverage rate than other states as the pandemic began and has largely maintained it over the last two years.
Massachusetts Health Connector 2021 Open Enrollment Period: Final Enrollment Results	06/08/2022	June 2022—In 2021, the passage of the American Rescue Plan (ARP) and its significant advancement of affordable health care induced the Health Connector to extend its Open Enrollment (OE) period. Typically, OE is from November 1 through January 23, but in 2021 was extended until July 23 to allow uninsured residents ample opportunity to access ARP-enhanced subsidies, including more robust Advance Premium Tax Credits (APTCs) and special benefits for members reporting unemployment income. The Health Connector enrolled 87,000 new members in Exchange coverage over the course of the 2021 OE period.
Data on the Massachusetts Individual Mandate: State Coverage Gains Under the Affordable Care Act	09/09/2021	August 2021 —Through affordable premiums and cost sharing, the Health Connector’s ConnectorCare program promotes access to care and reduced cost burdens for approximately 193,000 low-to-moderate income Massachusetts residents. As the state Marketplace’s flagship health insurance subsidy program, ConnectorCare offers the Commonwealth’s families comprehensive and high-quality health plan options with affordable premiums and point of care cost sharing.
Health Care Sharing Ministries Reporting to the Massachusetts Health Connector in 2020 and 2021	09/08/2021	September 2021 —A summary of information reported to the Health Connector by health arrangements provided by an established religious organization seeking minimum creditable coverage status for 2020 and 2021.
Massachusetts Cost Sharing Subsidies in ConnectorCare: Design, Administration, and Impact	08/30/2021	August 2021 —Through affordable premiums and cost sharing, the Health Connector’s ConnectorCare program promotes access to care and reduced cost burdens for approximately 193,000 low-to-moderate income Massachusetts residents. As the state Marketplace’s flagship health insurance subsidy program, ConnectorCare offers the Commonwealth’s families comprehensive and high-quality health plan options with affordable premiums and point of care cost sharing.
Getting to 100: What we know about the remaining uninsured in Massachusetts	03/22/2021	January 2021 —In 2019, less than 3 percent of Massachusetts residents, or roughly 200,000 people, lacked health insurance coverage. The Commonwealth’s highest-in-the-nation rate of coverage can be attributed to innovative state and federal reforms. While together these reforms expanded coverage to nearly half a million Massachusetts residents, in recent years the state’s insured rate has flattened, despite year-round outreach, an enduring state level individual mandate, and state subsidized ConnectorCare plans.
Massachusetts Health Connector COVID-19 Special Enrollment Period: Final Enrollment Results	09/01/2020	September 1, 2020—This brief is designed to provide final data and analysis on supports for state residents to access and maintain their coverage through the duration of the national COVID-19 crisis. The Health Connector established a Special Enrollment Period (SEP) for Massachusetts residents without health insurance coverage or those with coverage that may have become unaffordable.
Massachusetts Health Connector COVID-19 Special Enrollment Period: Results to Date	05/01/2020	May 1, 2020—This brief is designed to provide data and analysis (to-date) on supports for state residents to access and maintain their coverage through the duration of the national COVID-19 crisis. The Health Connector’s existing programs paired with new policy strategies aim to expand coverage to the remaining and newly uninsured (particularly those who may be losing job-based health coverage) and protect coverage for current members.
Striving for meaningful choice: Non-group health plans on the Massachusetts Health Connector product shelf	03/13/2019	January 2019—This brief is designed to provide data and analysis relative to the breadth of choices offered since the Health Connector’s inception to members purchasing outside the curated plan sets of Commonwealth Care or ConnectorCare. Although subsidized plans represent a larger share of the Health Connector’s membership, there are a limited number of standardized plans serving those members. Through examination of the way in which consumers select a single plan from the dozens available, the Health Connector will continue to refine its approach to plan offerings as well as tailoring decision support tools.
Massachusetts Medicaid Buy-in Study	02/06/2019	October 2018—Report on the feasibility of establishing a small employer premium sharing plan for participation in the MassHealth program.
FFRDC Technical Assistance Report: Commonwealth of Massachusetts Health Connector	02/04/2014

Public Comment Letters

Title	Create Date	Excerpt	Category
Comment Letter on the proposed rule, “Inadmissibility on Public Charge Grounds"	12/19/2025	The Massachusetts Health Connector has strongly opposed the Department of Homeland Security's proposed rule on "Inadmissibility on Public Charge Grounds." In a detailed comment letter, the Health Connector argues that the rule would create widespread fear and uncertainty, discouraging immigrant families, including those with U.S. citizen children, from enrolling in the health coverage they are legally entitled to receive.	Affordability, market stability, and consumer protection, Public Comment Letters
Comment Letter on the proposed rule, “Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability”	04/11/2025	The Massachusetts Health Connector submitted a public comment letter addressing concerns about the proposed Centers for Medicare & Medicaid Services (CMS) rule, "Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability." The letter highlights potential negative impacts on Massachusetts's unique merged individual and small group insurance market, including increased premiums, harm to the risk pool, and administrative burdens. The letter also emphasizes the Commonwealth's success in achieving near-universal coverage and maintaining program integrity through tailored, data-driven approaches.	Affordability, market stability, and consumer protection, Public Comment Letters
Comment Letter on the proposed rule, “HHS Notice of Benefit and Payment Parameters for 2026”	11/12/2024	The Massachusetts Health Connector provided detailed feedback on the 2026 NBPP proposed rule, advocating for key measures that enhance transparency in Marketplace operations and codify the use of silver-loading practices to maintain affordability. The agency also supports incorporating Pre-Exposure Prophylaxis (PrEP) into risk adjustment models to promote equitable access to preventive care. Highlighting the burden of medical debt, especially on vulnerable communities, the Health Connector emphasizes the need for increased education on financial assistance programs.	Notice of Benefit and Payment Parameters (NBPP), Public Comment Letters
Comment Letter on the proposed rule, “HHS Notice of Benefit and Payment Parameters for 2025”	01/08/2024	The Massachusetts Health Connector provided detailed feedback on the 2025 NBPP proposed rule, voicing strong support for robust network adequacy standards, a permanent special enrollment period (SEP) for low-income individuals, and expanding access to routine adult dental benefits. These measures aim to strengthen consumer protection, reduce barriers to coverage, and enhance access to essential health services.	Notice of Benefit and Payment Parameters (NBPP), Public Comment Letters
Comment Letter on the proposed rule, “Requirements Related to the Mental Health Parity and Addiction Equity Act”	10/03/2023	The Massachusetts Health Connector has voiced strong support for the proposed rule “Requirements Related to the Mental Health Parity and Addiction Equity Act,” emphasizing the critical need for equal access to mental health and substance use disorder benefits. The proposal comes at a time when the mental health crisis has intensified nationwide and in Massachusetts, with rising rates of psychological distress, substance use disorders, and barriers to care.	Affordability, market stability, and consumer protection, Public Comment Letters
Comment Letter on the proposed rule, “Short-Term, Limited-Duration Insurance; Independent, Noncoordinated Excepted Benefits Coverage; Level-Funded Plan Arrangements; and Tax Treatment of Certain Accident and Health Insurance”	09/01/2023	The Massachusetts Health Connector submitted a comment letter in support of proposed changes to regulations surrounding Short-Term, Limited-Duration Insurance (STLDI) and related coverage options. These updates aim to protect consumers and promote equitable access to comprehensive health care.	Affordability, market stability, and consumer protection, Public Comment Letters
Comment Letter on the Proposed Rule, “Clarifying Eligibility for a Qualified Health Plan Through an Exchange, Advance Payments of the Premium Tax Credit, Cost-Sharing Reductions, a Basic Health Program, and for Some Medicaid and Children’s Health Insurance Programs”	06/23/2023	The Massachusetts Health Connector has voiced its strong support for the proposed rule to expand health coverage eligibility to Deferred Action for Childhood Arrivals (DACA) recipients. By including DACA recipients as "lawfully present," this rule would grant access to crucial health programs such as Marketplace subsidies, Medicaid, and the Basic Health Program.	Immigrant status and health, Public Comment Letters
Comment Letter on the proposed rule, “Coverage of Certain Preventive Services under the Affordable Care Act”	04/03/2023	The Massachusetts Health Connector submitted a comment letter expressing strong support for the proposed rule, "Coverage of Certain Preventive Services under the Affordable Care Act." This rule aims to expand access to preventive services, including contraception, while addressing exemptions for entities with religious or moral objections.	Affordability, market stability, and consumer protection, Public Comment Letters
Comment Letter on the Proposed Rule, “HHS Notice of Benefit and Payment Parameters for 2024”	01/30/2023	The Massachusetts Health Connector has submitted its feedback on the proposed 2024 Notice of Benefit and Payment Parameters (NBPP) rule, supporting key measures like allowing income attestation flexibility, advancing auto-enrollment policies, and broadening special enrollment period options. These actions aim to enhance coverage access while reducing administrative hurdles that often deter individuals from securing insurance.	Notice of Benefit and Payment Parameters (NBPP), Public Comment Letters
Comment Letter on the Proposed Rule, “Nondiscrimination in Health Programs and Activities”	09/27/2022	The Massachusetts Health Connector has expressed strong support for the proposed rule to reinforce nondiscrimination protections in health programs and activities. Advocating for the inclusion of protections based on sexual orientation, gender identity, and language proficiency, the Health Connector emphasizes the critical role these measures play in ensuring equitable access to health care for all.	Nondiscrimination, Public Comment Letters
Comment Letter on the Proposed Rule, “Affordability of Employer Coverage for Family Members of Employees”	05/31/2022	The Massachusetts Health Connector has submitted a comment letter in support of the proposed rule addressing the affordability of employer-sponsored family coverage. The letter strongly endorses including family coverage costs in affordability assessments, aligning with the ACA's goals of ensuring meaningful access to affordable health care.	Affordability, market stability, and consumer protection, Public Comment Letters
Comment Letter on the Proposed Rule, “HHS Notice of Benefit and Payment Parameters for 2023”	01/27/2022	The Massachusetts Health Connector submitted feedback on the proposed 2023 NBPP rule, raising concerns about the State Exchange Improper Payment Measurement program due to its potential burden on state flexibility and innovation. The letter advocates for maintaining flexibility in actuarial value variations to preserve affordable plan options for consumers.	Notice of Benefit and Payment Parameters (NBPP), Public Comment Letters
Comment Letter on the Proposed Rule, “Patient Protection and Affordable Care Act; Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond”	07/28/2021	The Massachusetts Health Connector has provided robust feedback on the proposed 2022 NBPP updates, strongly supporting the repeal of the direct enrollment option to safeguard consumer protections and ensure transparency in health plan selection. The letter also endorses the restoration of the 2015 Section 1332 waiver guidance to uphold comprehensive coverage standards and promote health equity.	Notice of Benefit and Payment Parameters (NBPP), Public Comment Letters
Comment Letter on the Draft 2022 Federal Actuarial Value Calculator Methodology	12/24/2020	The Massachusetts Health Connector and Division of Insurance have shared key feedback on the draft 2022 Federal Actuarial Value Calculator Methodology. The comment letter emphasizes concerns over how the current methodology affects plan design, particularly for bronze-level plans, which are increasingly difficult to keep affordable and within federal standards.	Affordability, market stability, and consumer protection, Public Comment Letters
Comment Letter on the proposed rule, “Securing Updated and Necessary Statutory Evaluations Timely”	12/04/2020	The Massachusetts Health Connector has raised significant concerns about the proposed SUNSET rule, which could lead to the automatic expiration of vital health regulations if not reviewed in a timely manner. The Health Connector warns that this approach risks creating disruptions in health coverage and unpredictability in the insurance market, potentially harming consumers and states that rely on these protections.	Affordability, market stability, and consumer protection, Public Comment Letters
Comment Letter on the Proposed Rule, “Affidavit of Support on Behalf of Immigrants”	11/02/2020	The Massachusetts Health Connector has voiced strong opposition to the proposed rule on the Affidavit of Support for immigrants, citing concerns over its detrimental effects on both health coverage and economic stability within the state. The letter highlights how the rule could deter immigrant families from accessing essential health care, undermining the Commonwealth’s pursuit of near-universal insurance coverage.	Immigrant status and health, Public Comment Letters
Comment Letter on the proposed rule, “Certain Medical Care Arrangements”	08/10/2020	The Massachusetts Health Connector has submitted a comment letter addressing concerns about the proposed rule on Certain Medical Care Arrangements. The Health Connector emphasizes the risks of consumer confusion with health care sharing ministries, which often lack the protections of ACA-compliant insurance.	Affordability, market stability, and consumer protection, Public Comment Letters
Comment Letter on the Proposed Rule, “Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2021; Notice Requirement for Non-Federal Governmental Plans”	02/28/2020	The Massachusetts Health Connector provided feedback on the proposed 2021 Benefit and Payment Parameters, emphasizing the importance of maintaining automatic re-enrollment to ensure coverage continuity for residents. The letter highlights the critical need for state flexibility in managing eligibility processes, allowing tailored solutions that align with local market dynamics.	Notice of Benefit and Payment Parameters (NBPP), Public Comment Letters

Data on the Individual Mandate

December 2019 — Data on the Massachusetts Individual Mandate: Health Connector Analysis of Department of Revenue Tax Filers Data Tax Years 2013–2015

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.

Leading the Way

Massachusetts has the highest rate of insured residents in the nation, 96.3%. Reform has improved thousands of lives, and has only added 1% in new costs to the state budget, according to an independent analysis.

Reports to the Massachusetts Legislature

These data-rich reports provide a comprehensive review of our work each year.

Progress Reports

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

Sharing Lessons Learned

Historical, pre-Affordable Care Act, studies and toolkits examine the Massachusetts health reform model and can inform the work of other states.

Market-wide Risk Adjustment

The Health Connector administered the market-wide risk adjustment program for the small and non-group merged market for plan years effective January 1, 2014 through December 31, 2016.

Beginning in 2017, the U.S. Department of Health and Human Service began conducting risk adjustment for the Massachusetts market.

The Massachusetts-specific approach to risk adjustment was 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: