An Act preventing medical debt by restoring health safety net eligibility levels

194th Legislature (2025-2026) Introduced by Sal DiDomenico

Expands Health Safety Net eligibility to 400% FPL for uninsured/underinsured, may impose deductibles above 200% FPL, and retroactively covers up to 180 days prior.

House concurred

Purpose and intent

This bill aims to reduce medical debt by expanding and clarifying eligibility for the Massachusetts Health Safety Net (HSN). It seeks to raise the income eligibility up to 400% of the federal poverty level (FPL) for uninsured or underinsured individuals and to establish potential deductibles for higher-income applicants, along with ensuring retroactive coverage. The act also creates a process for evaluating the financing of the Health Safety Net Trust Fund (HSNTF) to address fund shortfalls and the overall sustainability of the program.

Key provisions

Section 1

Inserts cross-reference to the new eligibility framework in the HSN eligibility determinations. Specifically, it ties eligibility determinations to the forthcoming subsection (c) of Section 65 of Chapter 118E.

Section 2 — New eligibility framework (subsection (c) added to Section 65)

The office shall develop eligibility criteria for uninsured/underinsured patients, including:
1) Eligibility up to 400% FPL for uninsured/underinsured individuals, subject to office-determined criteria.
2) If income exceeds 200% but does not exceed 400% FPL, eligible patients may be subject to a deductible.
3) Eligibility shall be retroactive to at least 180 days prior to the application date. The office may set higher income thresholds and/or provide greater retroactive coverage if warranted.

Notes:
- Subsection (c) is intended to be implemented alongside existing criteria; nothing prevents higher thresholds or broader retroactive coverage beyond the stated parameters.

Section 3 — Task force on HSNTF financing

Establishes a task force, convened by the Health Safety Net Office in consultation with the Office of Medicaid, to study the financing of the HSNTF (funded through hospital payments, ambulatory surgical centers, and surcharge payors; and disbursements/reimbursements to hospitals and community health centers).

Composition: includes a consumer advocate representative, a hospital representative, a community health center representative, and a health insurance plan representative, among others.

Timeline:

All appointments within 30 days after the effective date.
Task force to meet within 60 days after the effective date.
Report to the General Court within 1 year after the effective date, detailing findings and recommendations.

Who is affected

Uninsured and underinsured Massachusetts residents, particularly those earning up to 400% FPL.

Individuals with income above 200% FPL may face a deductible under the new framework.

Hospitals, ambulatory surgical centers, community health centers, health insurers, and the HSNTF as the financing mechanism for the Health Safety Net.

The Health Safety Net Office and the Office of Medicaid, which will administer eligibility and coordinate the financing study.

Procedural and timeline notes

The bill proposes a distinct implementation path with a new eligibility subsection and a mandatory financing task force.

Appointments and initial meetings occur soon after the bill’s effective date, with a formal report due within one year of that date.

The current status reflects House concurrence with the Senate version as of February 27, 2025.

Bill