MassHealth

MassHealth is the Massachusetts Medicaid program. Funded by both federal and state dollars, MassHealth provides health coverage to approximately 1.7 million low- and moderate-income people and persons with disabilities, including close to one in three children. In large part thanks to MassHealth, nearly all children in Massachusetts have health insurance today.

Children under age 19 (and those under age 26 who have aged out of foster care) who are enrolled in MassHealth receive health coverage through one of several plans. Children with family incomes under 150 percent of the federal poverty level are typically enrolled in MassHealth Standard, the most comprehensive coverage type, and usually receive care through a managed care plan, or in some cases through a fee-for-service arrangement. Children with incomes between 150 percent and 300 percent of the federal poverty level receive coverage through MassHealth Family Assistance, which allows them to enroll directly in a MassHealth plan or receive assistance towards premium costs for private coverage.

Children with disabilities who are not eligible for MassHealth Standard may be eligible for CommonHealth, regardless of income. The Children's Medical Security Plan provides more limited coverage for children who are not eligible for MassHealth. Children enrolled in MassHealth are also eligible for enhanced mental health services through the Children's Behavioral Health Initiative.

MassHealth was created in 1997 after the federal government allowed Massachusetts to expand its Medicaid program to cover more children and certain adults. Passage of the Federal Children's Health Insurance Program (CHIP) later in 1997 allowed the state to expand coverage further, and in 2006 Massachusetts again expanded eligibility to allow children in families with incomes up to 300 percent of the federal poverty level to enroll in MassHealth. With the implementation of the Affordable Care Act In 2014, the program expanded eligibility even further.

Because funding for MassHealth comes from both state and federal revenues, the state is reimbursed by the federal government for more than half of the costs of care, with reimbursements ranging from 50 percent of the costs to almost 100 percent of costs. Note that this Children's Budget only includes a selection of the MassHealth line items. Furthermore, MassHealth line items in the state budget do not always correspond directly to individual coverage programs, and there are often shifts in funding among line items during the course of a fiscal year. For these reasons, use caution when comparing line items from year to year.

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