About this Site

Massachusetts offers relatively broad opportunities to secure health insurance coverage through a complex set of public-sector programs or assistance in paying for employer-sponsored health insurance. The Center for Health Policy and Research (CHPR) at the University of Massachusetts Medical School and the Massachusetts Medicaid Policy Institute (MMPI) have collaborated to create a resource to describe these programs and educate the health care community and other important stakeholders about public health insurance coverage in Massachusetts.

Our publication and website highlight coverage options and health care resources available to low-income individuals and families, elderly individuals, and individuals with disabilities throughout Massachusetts. By providing this information, we hope to increase knowledge of public health insurance programs in the Commonwealth, illustrate the eligibility pathways into these insurance programs, and identify gaps in the current system that lead to uninsured residents.

Setting the Stage for Pathways to Coverage 

Most non-elderly individuals, in Massachusetts and the rest of the country, secure health insurance through their employers. Massachusetts also offers relatively broad opportunities to secure coverage through public-sector programs or assistance in paying for employer-sponsored health insurance. This publication highlights these coverage options and the health care resources available to the uninsured, underinsured, elderly, and residents with disabilities of Massachusetts.

The major programs are:

Medicaid is the nation’s major public health insurance program for certain qualified low-income Americans and is jointly funded by each state and the federal government. The Massachusetts Medicaid program, called MassHealth (a name used for the state’s Medicaid program, the State Children’s Health Insurance Program, and other jointly-funded state health programs), provides comprehensive health insurance — or assistance in paying for private health insurance — to over one million Massachusetts residents including children, families, adults, seniors, and people with disabilities.

Medicare is a federal health insurance program that provides benefits to individuals who have contributed to the federal social security program as employees for a sufficient number of years and have reached the age of 65, or have a disabling condition which meets federal criteria.  This program is not a needs-based program, but a federally-administered employee benefit, so individuals qualify without regard to income, assets, or pre-existing medical conditions.  Almost one million Massachusetts residents are enrolled in Medicare.

All children under the age of 19 who do not qualify for MassHealth (except MassHealth Limited) are eligible for health insurance coverage through the Children’s Medical Security Program (CMSP). CMSP provides primary and preventive medical, dental, and mental health coverage.

There are anywhere from 372,000 to 618,000 Massachusetts residents who do not have any health insurance, according to the latest surveys from state and federal sources. The Commonwealth Care Health Insurance Program, a new public program to assist people in purchasing private insurance, is for uninsured adults earning at or below 300% of the Federal Poverty Level (FPL) who do not otherwise qualify for MassHealth or Medicare, and do not have access to affordable employer-sponsored coverage. Visit the Commonwealth Care website (www.mass.gov/connector) or call 1-877-MA-ENROLL (1-877-623-6765) for more information.

The Massachusetts Uncompensated Care Pool partially reimburses hospitals and community health centers for the care they provide to low-income, uninsured, or underinsured people. Hospitals and health centers qualify for reimbursement for costs incurred by serving patients with a household income at or below 200% FPL who do not have other coverage, while a lower level of reimbursement is available for costs incurred in serving patients whose incomes are between 200-400% FPL.  For patients with incomes above 400% FPL, medical hardship assistance may be available if medical costs are very high, i.e., exceeding a threshold percentage of household income.

The information on this website was accurate as of December 2006. These charts are meant to be a guide and educational tool; they are not meant as a comprehensive review of the eligibility determination process. To determine actual eligibility for any of these programs, we strongly encourage any potentially eligible individual to apply for these programs by calling MassHealth’s customer service number 1-800-841-2900 or visiting their website at www.mass.gov/masshealth.

Project Team: 
Aniko Laszlo
Heather Strother
Michael Tutty
Eric Masters
Robert Seifert
Jay Himmelstein

Acknowledgements: 
The project team would like to thank the following people for their gracious assistance, without which this project would not have been possible: