MassHealth Baseline Statistics from the MA APCD


Publication Materials

MassHealth Graphic

CHIA for the first time has produced MassHealth Baseline Statistics from the MA APCD. This report provides an overview of the MassHealth population, with a focus on spending for members with Standard coverage in the Fee-For-Service (FFS) and the Primary Care Clinician (PCC) plan delivery systems between state fiscal years 2013-2014. The analysis is based on enhanced eligibility data that MassHealth began submitting to the MA APCD in 2015.

CHIA plans to validate and report on expenditure data for the MassHealth managed care entities from the MA APCD in future reports.

Key Findings In State Fiscal Year 2014

  • One in four Massachusetts residents were enrolled in MassHealth.

  • MassHealth provided secondary coverage for 26% of its membership who receive primary coverage from other insurance, including through premium assistance.

  • Average monthly membership increased by 13% from the previous year to 1.6 million members, primarily due to expanded eligibility under the Affordable Care Act (ACA) beginning January 1, 2014. Non-disabled adults in MassHealth increased by 36% compared to the previous year.

  • Nearly 60% of the MassHealth population received coverage through the FFS or the PCC Plan delivery systems.

  • Standard coverage, the most robust set of MassHealth benefits, accounted for 93%, or $7.2 billion, of spending in these two delivery systems.

  • $4.4 billion, or 62% of Standard coverage spending for FFS and PCC Plan members was on long term services and supports (LTSS), which are typically only covered by Medicaid programs.

  • FFS Standard enrollees who also had Medicare accounted for $3.8 billion in MassHealth spending; 90% of this spending was on LTSS.

 

The accompanying databook has additional information and population breakouts, while the technical appendix provides additional technical details related to data sources, preparation and categorization.