The Massachusetts Medicaid program, MassHealth, plays a critical role as a source of health insurance coverage in Massachusetts. It covers a broad range of residents of the commonwealth, including vulnerable populations such as seniors, people with disabilities, and children. It has also become a significant source of coverage for low-income, nondisabled adults ever since the implementation of coverage expansions under the Affordable Care Act. In total, the program now covers approximately one in four Massachusetts residents.

While Massachusetts has made considerable advances in healthcare coverage and access for its residents, the state has also seen the MassHealth budget grow substantially in recent years. In response, the state has sought to address MassHealth spending growth through a number of channels, including by establishing the Health Policy Commission and the Center for Health Information and Analysis in 2012 to study and monitor healthcare payment and delivery issues in the state. In 2017, it launched ambitious Medicaid Accountable Care Organizations, which now enroll nearly half of MassHealth enrollees and contain significant accountability mechanisms related to quality and total cost of care.