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SD 3985

Children’s Medical Security Plan Second Quarter FY25 Report

194th Legislature (2025-2026)

Starting January 1, 2025, CMSP premiums are zero for those up to 300% FPL and copayments are eliminated for all members.

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Bill Summary · SD 3985

Overview

  • Bill: SD 3985 | Session: 194th | Jurisdiction: Massachusetts
  • Title: Children’s Medical Security Plan Second Quarter FY25 Report
  • Purpose: Provide an official quarterly Legislative Report on the Massachusetts Children’s Medical Security Plan (CMSP) for the second quarter of Fiscal Year 2025 (FY25 Q2: October 1, 2024 – December 31, 2024). The report communicates eligibility data, utilization, and expenditures, and notes policy changes affecting CMSP premiums and copayments effective January 1, 2025.

Main Purpose and Intent

  • To document and communicate CMSP activity for FY25 Q2 to the Legislature and stakeholders.
  • To inform on eligibility levels, utilization, and total expenditures for CMSP.
  • To announce and reflect changes in CMSP premium structure and copayment policy implemented retroactively or prospectively starting January 1, 2025.

Key Provisions and Changes

  • Premiums:
    • Effective January 1, 2025, CMSP enrollees with income up to 300% of the Federal Poverty Level (FPL) have premiums set to zero.
    • Enrollees with incomes above 300% of the FPL are subject to a sliding-scale premium structure.
  • Copayments:
    • Effective January 1, 2025, all copayments for CMSP members are eliminated.
  • Reporting and Data:
    • The report provides enrollment figures, utilization metrics, and spending by service type (medical, dental, pharmacy) for the second quarter of FY25.
    • Enrollment data illustrate the number of CMSP-eligible children at quarter-end, and the monthly end-of-period eligibility figures.
  • Administrative details:
    • The report is prepared by the Massachusetts Executive Office of Health and Human Services, Office of Medicaid, and submitted to the Joint Committees on Health Care Financing (Senate and House) and their respective chairs.

Who is Affected

  • CMSP-eligible children and adolescents (birth to 18) who are not eligible for MassHealth benefits (except MassHealth Limited) and are not otherwise insured.
  • CMSP enrollees, particularly those with incomes up to 300% FPL who will benefit from zero premiums beginning January 1, 2025.
  • CMSP members who incur copayments, which will be eliminated starting January 1, 2025.
  • Families and guardians of CMSP-eligible children who rely on CMSP for primary and preventive health care services.

Data Highlights (FY25 Q2: Oct 1 – Dec 31, 2024)

  • Eligibility:
    • End of Q2: 87,730 children eligible for CMSP.
    • Monthly end-of-period eligibility: Oct 2024 = 84,912; Nov 2024 = 82,879; Dec 2024 = 87,730.
  • Utilization and Expenditures (FY25 Q2):
    • Medical Claims: 113,867 total claims; $8,444,691 paid; 38,519 member count; 13,620 claims in Oct, 12,288 in Nov, 12,611 in Dec.
    • Dental Claims: 61,503 total claims; $3,089,092 paid; 14,296 member count; 5,011 in Oct, 4,686 in Nov, 4,599 in Dec.
    • Pharmacy Claims: 10,435 total claims; $195,337 paid; 6,508 member count; 2,311 in Oct, 2,133 in Nov, 2,064 in Dec.
  • Total Expenditures:
    • Combined total expenditures for FY25 Q2: $11,729,120.
    • Totals by category reflect the sum of medical, dental, and pharmacy payments across Oct–Dec 2024.
  • Total CMSP claims filed in the quarter: 185,805 (medical 113,867; dental 61,503; pharmacy 10,435).

Procedural and Timeline Aspects

  • Reporting Schedule:
    • This is a quarterly legislative report covering the second quarter of FY2025 (October 1–December 31, 2024).
  • Implementation Timeline:
    • Premium and copayment policy changes take effect January 1, 2025.
    • Premiums reduced to zero for enrollees with income up to 300% FPL; sliding-scale premiums for higher incomes.
    • Copayments eliminated for CMSP members starting January 1, 2025.
  • Submission and Communication:
    • Report prepared by the Massachusetts Executive Office of Health and Human Services, Office of Medicaid.
    • Distributed to Chairs of the Senate and House Ways and Means Committees and Health Care Financing Committees, with contact and agency details provided.

Practical Implications

  • Financial relief for CMSP-eligible families with incomes up to 300% FPL due to zero premiums and no copays starting in 2025.
  • The data indicate ongoing utilization of CMSP across medical, dental, and pharmacy services, with substantial total expenditures in FY25 Q2.
  • Provides legislators and stakeholders with a transparent view of CMSP’s reach and cost structure during the referenced quarter.

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

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