MassHealth, the state’s combined Medicaid and Children’s Health Insurance Program [CHIP], provides healthcare coverage to Massachusetts’ highest need residents. MassHealth enrollees have access to doctor and hospital visits, prescription drugs, and other important healthcare services.1 The program also represents the largest category of spending in the state budget, making up 35 percent ($19.8 billion) of total state spending in Fiscal Year (FY) 2024. Prior to the pandemic, an average of 1.76 million individuals were enrolled in the MassHealth program each month. By April 2023, enrollment in MassHealth had grown to 2.42 million individuals, an increase of 659,000 (38 percent).

This dramatic increase in MassHealth enrollment was a result of the COVID-19 pandemic, the declaration of a federal Public Health Emergency (PHE), and two related policy changes at the federal level. The Medicaid response to the pandemic not only had significant impacts on MassHealth enrollment trends, but also the state budget and the healthcare system overall. Now, twelve months after the end of the PHE, the unwinding of these policies will have an equally seismic effect as routine redeterminations continue and federal reimbursement revenue declines.