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SD 3986

Children’s Medical Security Plan Third Quarter FY25 Report

194th Legislature (2025-2026)

CMSP provides data on quarterly eligibility, utilization, and expenditures, with premiums and copays eliminated up to 300% FPL to improve access for eligible children.

Placed on file
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Bill Summary · SD 3986

Summary: Children’s Medical Security Plan Third Quarter FY25 Report (SD 3986, 194th MA Legislature)

This document is a legislative report from the Massachusetts Executive Office of Health and Human Services detailing the Children’s Medical Security Plan (CMSP) for the third quarter of Fiscal Year 2025 (January 1 – March 31, 2025). It provides program status, eligibility, utilization, and expenditure data rather than introducing new policy provisions. The report is submitted to the Chairs and committees of the Senate and House Ways and Means and Health Care Financing.

Purpose and intent

  • To provide a transparent, data-driven update on CMSP activities and financials for a specified quarter.
  • To document eligibility levels, service utilization, and total expenditures related to CMSP.

Key provisions and changes (as included in the report)

  • This item is a quarterly reporting requirement for CMSP rather than a substantive policy change bill. The primary content is the quarterly data snapshot and narrative about program operations.

Who or what is affected

  • CMSP-eligible children and adolescents (birth through 18) in Massachusetts.
  • CMSP-eligible individuals who are not enrolled in other MassHealth benefits (with the exception of MassHealth Limited).
  • Families and caregivers of eligible children, insurers, and healthcare providers serving CMSP enrollees.

Data highlights from FY25 Q3 (January 1 – March 31, 2025)

  • Eligibility snapshot (end of quarter): 83,451 children eligible for CMSP.
    • Note: Eligibility does not confirm actual service usage; utilization data are provided separately.
  • Enrollee premiums: Effective January 1, 2025, premiums for enrollees with income up to 300% of the Federal Poverty Level (FPL) were set to zero; premiums for incomes above 300% FPL are on a sliding scale. All copayments were eliminated for CMSP members as of January 1, 2025.
  • Enrollment by month-end:
    • January 2025: 85,376
    • February 2025: 85,468
    • March 2025: 83,451
  • Spending by service type (FY25 Q3):
    • Medical claims: $8,991,834.91 total; 39,783 member claims; 118,638 medical claims across the quarter (monthly breakdown below)
    • January: $3,334,009.74; 14,608 members; 44,008 claims
    • February: $2,809,348.54; 12,745 members; 37,617 claims
    • March: $2,848,476.63; 12,430 members; 37,013 claims
    • Dental claims: $2,556,281.03 total; 12,862 members; 55,106 claims across the quarter
    • January: $1,125,858.43; 5,438 members; 23,861 claims
    • February: $1,032,218.60; 5,288 members; 22,438 claims
    • March: $398,204.00; 2,136 members; 8,807 claims
    • Pharmacy claims: $201,813.48 total; 6,562 members; 10,566 claims across the quarter
    • January: $75,332.78; 2,390 members; 3,926 claims
    • February: $61,923.70; 1,984 members; 3,212 claims
    • March: $64,557.00; 2,188 members; 3,428 claims
  • Total expenditures for FY25 Q3: $11,749,929.40
  • Total CMSP claims filed in the quarter: 184,310
    • Medical claims: 118,638
    • Dental claims: 55,106
    • Pharmacy claims: 10,566

Procedural and timeline aspects

  • Reporting period: Third quarter of Fiscal Year 2025 (January 1 – March 31, 2025).
  • Submission status: Placed on file on June 11, 2026.
  • The report accompanies ongoing CMSP administration and is intended for legislative oversight and transparency rather than to enact new rules.

Practical implications and potential impact

  • Financial: Demonstrates the scale of CMSP expenditures and utilization, informing budgeting and policy discussions.
  • Access and affordability: With premiums eliminated up to 300% FPL and copays removed, CMSP becomes more accessible to low- and moderate-income families.
  • Enrollment dynamics: A noticeable drop in end-of-quarter eligibility from February to March (85,468 to 83,451) may warrant analysis to understand churn or eligibility changes.
  • Utilization patterns: Medical services account for the largest share of expenditures, followed by dental and pharmacy, indicating areas of emphasis for preventive and ongoing pediatric care.

If you want, I can extract specific figures into a concise data table or compare these quarter results to prior quarters for trend analysis.

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

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