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 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
- Facts and Figures
- Leading the Way
- FFRDC Technical Assistance Report: Commonwealth of Massachusetts Health Connector
- Progress Reports
- Sharing Lessons Learned
- Ensuring Students Get Coverage
- Market-wide Risk Adjustment
- Reports to the Massachusetts Legislature
- Data on the Individual Mandate
- Health Care in Massachusetts: Key Indicators
- Programmatic Audit Reports
- Financial Statement Audits
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.
Leading the Way
Massachusetts has the highest rate of insured residents in the nation, 98.1%. Reform has improved thousands of lives, and has only added 1% in new costs to the state budget, according to an independent analysis.
- Health Connector 2013-2015 Strategic Plan-in-Brief(or download an accessible Word document for the visually impaired)
- 10 Things You May Not Know
- Read our facts and figures
- Blue Cross Blue Shield of Massachusetts Foundation – Assessing the Results
- Blue Cross Blue Shield of Massachusetts Foundation – Massachusetts Health Reform: A Five-Year Progress Report
- Massachusetts Taxpayers Foundation – An Update on the ‘Budget Buster’ Myth
- Business Community Participation in Health Reform: The Massachusetts Experience, 2012
FFRDC Technical Assistance Report: Commonwealth of Massachusetts Health Connector
The Commonwealth requested technical assistance from Centers for Medicare & Medicaid Services (CMS), its federal partner, in evaluating the construction of the Massachusetts health care Marketplace (HIX/IES). CMS requested IT and systems engineering assistance from The MITRE Corporation (MITRE), operator of the CMS Alliance to Modernize Healthcare (CAMH) Federally Funded Research and Development Center (FFRDC). MITRE has developed substantive knowledge and understanding of the Commonwealth’s systems development life cycle. MITRE has also provided technical guidance and assistance to the Commonwealth through its engagement with CMS in supporting and assessing various stages of development through gate reviews.
Progress Reports
Each year, the Health Connector publishes a booklet highlighting what we’ve accomplished and who we’ve helped.
Sharing Lessons Learned
Studies and toolkits examine the Massachusetts model and can inform the work of other states.
- Blue Cross Blue Shield of Massachusetts Foundation – Lessons from the Implementation of Massachusetts Health Care Reform
- Toolkit #1 – Building an Effective Health Insurance Exchange Website
- Toolkit #2 – Implementing a Successful Public Outreach and Marketing Campaign
- Toolkit #3 – Determining Health Benefit Designs
- Toolkit #4 – Mitigating Risk in a State Health Insurance Exchange
- Toolkit #5 – Effective Education, Outreach and Enrollment for Populations Newly Eligible for Health Coverage
- Georgetown University and the Robert Wood Johnson Foundation – The Massachusetts and Utah Health Insurance Exchanges: Lessons Learned
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:
- Technical specifications workbook—Published November 2015
- Technical specifications workbook—Published April 2013
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:
- Commonwealth of Massachusetts Notice of Benefit and Payment Parameters 2015 (PDF), released April 10, 2014
- Commonwealth of Massachusetts Notice of Benefit and Payment Parameters 2014 (PDF), released April 10, 2013
Reports to the Massachusetts Legislature
These data-rich reports provide a comprehensive review of our work each year.
- Read the Health Connector’s 2017 Report to the Legislature
- Read the Health Connector’s 2016 Report to the Legislature
- Read the Health Connector’s 2014 & 2015 Report to the Legislature
- Read the Health Connector’s 2013 Report to the Legislature
- Read the Health Connector’s 2012 Report to the Legislature
- Read the Health Connector’s 2011 Report to the Legislature
- Read the Health Connector’s 2010 Report to the Legislature
- Read the Health Connector’s 2009 Report to the Legislature
- Read the Health Connector’s 2008 Report to the Legislature
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:
- Massachusetts Residents without Health Insurance Coverage: Understanding Those at Risk of Long-Term Uninsurance
- The Remaining Uninsured in Massachusetts: Experiences of Individuals Living Without Health Insurance Coverage
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 →
Programmatic Audit Reports
2017
- Commonwealth Health Insurance Connector Authority Performance Audit of Centers for Medicare and Medicaid Services (CMS) Rule 9957 Requirements
For the Period of July 1, 2016–June 30, 2017—Published June 1, 2018
2016
- Commonwealth Health Insurance Connector Authority Performance Audit of Centers for Medicare and Medicaid Services (CMS) Rule 9957 Requirements
For the Period of July 1, 2015–June 30, 2016—Published July 14, 2017
2015
- Commonwealth Health Insurance Connector Authority Performance Audit of Centers for Medicare and Medicaid Services (CMS) Rule 9957 Requirements
For the Period of January 1–June 30, 2015—Published March 24, 2016
2014
- Commonwealth Health Insurance Connector Authority Performance Audit of Centers for Medicare and Medicaid Services (CMS) Rule 9957 Requirements
For the Year Ended December 31, 2014—Published May 28, 2015
Financial Statement Audits
Fiscal Year 2017 (July 1, 2016–June 30, 2017)
- Independent Auditors’ Reports as Required by Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance) and Government Auditing Standards and Related Information (PDF)
- Financial Statements and Required Supplementary Information (PDF)
Fiscal Year 2016 (July 1, 2015–June 30, 2016)
- Independent Auditors’ Reports as Required by Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance) and Government Auditing Standards and Related Information (PDF)
- Financial Statements and Required Supplementary Information (PDF)
Fiscal Year 2015 (July 1, 2014–June 30, 2015)
- Independent Auditors’ Reports as Required by Office of Management and Budget (OMB) Circular A-133 and Government Auditing Standards and Related Information (PDF)
- Financial Statements and Required Supplementary Information (PDF)
Fiscal Year 2014 (July 1, 2013–June 30, 2014)