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HD 5816

A communication from the Executive Office of Health and Human Services (see Section 10F of Chapter 118E of the General Laws) submitting a quarterly report for the third quarter of fiscal year 2025 legislative report for the Children’s Medical Security Plan

194th Legislature (2025-2026)

CMSP now charges no premiums up to 300% FPL and eliminates copays, expanding access for eligible children and adolescents not covered by MassHealth.

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Bill Summary · HD 5816

Summary of Bill HD 5816 (Session 194th) – Massachusetts

Note: This bill is a communication from the Executive Office of Health and Human Services presenting a quarterly legislative report for the Children’s Medical Security Plan (CMSP) for the third quarter of Fiscal Year 2025. It is not a standalone piece of legislation proposing new policy changes, but a reporting document accompanying CMSP data and program updates.

1) Purpose and Intent

  • Provide a formal legislative report on CMSP for the third quarter of FY2025 (January 1 – March 31, 2025), including eligibility data, utilization, and expenditures.
  • Transparently communicate CMSP demographics, enrollment, and spending to the Legislature (Chairs of Ways and Means and Health Care Financing committees in both chambers).

2) Key Provisions and Changes Highlighted in the Report

  • CMSP Overview:
    • CMSP offers primary and preventive health care access to eligible children and adolescents (birth to 18) who are not eligible for MassHealth benefits (except MassHealth Limited) and who are not otherwise insured.
  • Premiums and Copayments (Effective Jan 1, 2025):
    • Enrollee premiums set to zero for income up to 300% of the Federal Poverty Level (FPL).
    • Premiums on a sliding scale for enrollees with incomes above 300% FPL.
    • All copayments eliminated for CMSP members.
  • Enrollment and Eligibility (End of Q3 FY2025):
    • Total CMSP-eligible children: 83,451 as of March 31, 2025.
    • Enrollment trend during the quarter:
    • January 2025: 85,376 eligible
    • February 2025: 85,468 eligible
    • March 2025: 83,451 eligible
    • Note: Eligibility does not equate to actual utilization of CMSP services.
  • Expenditures and Utilization (Quarterly Breakdown for Q3 FY2025):
    • Medical Claims:
    • Total: $8,991,834.91
    • Member count: 39,783 claims (118,638 total medical claims across the quarter)
    • Monthly highlights: Jan ($3,334,009.74; 14,608 members; 44,008 claims), Feb ($2,809,348.54; 12,745 members; 37,617 claims), Mar ($2,848,476.63; 12,430 members; 37,013 claims)
    • Dental Claims:
    • Total: $2,556,281.03
    • Member count: 12,862 (55,106 total dental claims across the quarter)
    • Monthly highlights: Jan ($1,125,858.43; 5,438 members; 23,861 claims), Feb ($1,032,218.60; 5,288 members; 22,438 claims), Mar ($398,204; 2,136 members; 8,807 claims)
    • Pharmacy Claims:
    • Total: $201,813.48
    • Member count: 6,562 (10,566 total pharmacy claims across the quarter)
    • Monthly highlights: Jan ($75,332.78; 2,390 members; 3,926 claims), Feb ($61,923.70; 1,984 members; 3,212 claims), Mar ($64,557; 2,188 members; 3,428 claims)
    • Overall Quarterly Expenditures:
    • Total CMSP expenditures for Q3 FY2025: $11,749,929.40
    • Breakdown: Medical ($8,991,834.91), Dental ($2,556,281.03), Pharmacy ($201,813.48)
    • Total Claims Filed in Q3 FY2025: 184,310 (118,638 medical + 55,106 dental + 10,566 pharmacy)

3) Who or What is Affected

  • Eligible Enrollees:
    • Children and adolescents from birth to 18 years old who are not eligible for MassHealth (except MassHealth Limited) and who are not otherwise insured.
    • Affects CMSP participants and potential beneficiaries within Massachusetts.
  • Public Health Funding and Policy:
    • Impacts CMSP funding allocation and program administration as reflected in quarterly reporting and expenditure data.
    • Reflects policy adjustments effective January 1, 2025 (premium elimination for lower-to-moderate incomes and copay elimination).

4) Procedural and Timeline Aspects

  • Reporting Cycle:
    • This document is the quarterly legislative report for CMSP, covering January 1, 2025 – March 31, 2025 (Q3 FY2025).
    • The report is prepared by the Massachusetts Executive Office of Health and Human Services, Office of Medicaid.
  • Submission and Distribution:
    • Provided to legislative chairs of the Joint Committee on Health Care Financing and related Senate/House Ways and Means committees.
    • Dated June 9, 2026, with the action history noting the document was placed on file on July 2, 2026.

5) Notable Observations

  • Premium and copay elimination as of 2025 may influence enrollment growth and utilization patterns going forward (consistent with broader access-to-care objectives).
  • There is a slight decline in total CMSP-eligible children from January to March 2025, warranting attention to enrollment dynamics or eligibility processing.
  • Utilization rates (medical, dental, pharmacy) are substantial, reflecting ongoing engagement with CMSP services within the eligible population.

If you want, I can convert these details into a concise one-page briefing or extract specific figures into a table for quick reference.

Compiled from official sources — confirm details with the bill’s official record.

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