Health Safety Net
Annual Report
Fiscal Year 2023
November 2024
 Table of Contents
Introduction 3
HSN Overview 4
HSN Fiscal Year Updates 2023 7
HSN Total Demand and Payment Trends 8
Hospital Payments & Volumes 9
Community Health Centers (CHC) Disbursements 10
Hospital Demand by Type of Service 11
CHC Demand by Type of Service 12
Utilization by Income (Federal Poverty Level) 13
Executive Office of Health and Human Services
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 Introduction
Introduction
The Executive Office of Health and Human Services (EOHHS) hereby submits this report to the
Massachusetts Legislature in compliance with Chapter 227 of the Acts of 2021, Line Item 4000-0300,
which calls for EOHHS to report on the utilization of the Health Safety Net Trust Fund, including the
following information for Fiscal Year 2023:
• The total dollar amount billed to the Health Safety Net Trust Fund.
• The types of services paid for out of the Health Safety Net Trust Fund.
• The amount disbursed from the Health Safety Net Trust Fund to each hospital and community
health center.
This report reflects Health Safety Net (HSN) utilization during HSN fiscal year 2023 (HSNFY23), which ran
from October 1, 2022 through September 30, 2023.
Note: The shortfall amount is subject to change. The Health Safety Net does not close a fiscal year until
two years after it’s end date to allow for claim adjustments and remediated claim submissions.
Executive Office of Health and Human Services
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 Introduction
HSN Overview
The Health Safety Net (HSN), created by Chapter 58 of the Acts of 2006, makes payments to hospitals
and community health centers for health care services provided to low-income Massachusetts residents
who are uninsured or underinsured.
• Massachusetts residents who are uninsured or underinsured and have household incomes up
to 150% of the Federal Poverty Level (FPL) may qualify for HSN primary or HSN secondary.
• If residents have incomes above 150% and up to 300% of the FPL, they may qualify for primary
partial HSN or secondary partial HSN, which includes a sliding scale deductible based on
income.
• Low income residents who are enrolled in MassHealth, Medicare or other insurance may
qualify for HSN secondary for certain services not covered by their primary insurance.
• Individuals eligible for ConnectorCare (regardless of enrollment) are eligible for HSN for the first
100 days of eligibility, after such time they are eligible for HSN dental only.
• If a Massachusetts resident has allowable medical expenses that exceed a certain percent of
their countable income, they may qualify for Medical Hardship, in which case the HSN would
pay for HSN qualified services. Individuals who qualify for Medical Hardship must pay a
required contribution, based on their family’s countable income.
Executive Office of Health and Human Services
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 Introduction
HSN Overview
The HSN pays acute hospitals and community health centers based on MassHealth payable services
that are eligible for payment. HSN payment rates for most services are based on Medicare payment
principles.
The HSN funding total for FY23 was $346,617,348 from the following sources:
• An assessment on acute hospitals’ private sector charges: $165,308,6741
• A surcharge on payments made to hospitals and ambulatory surgical centers by HMOs,
insurers, third party administrators, and individuals (assessment and surcharge are each equal
to $160 million plus 50% of the estimated cost of administering the Health Safety Net):
$165,308,6741
• A $16 million appropriation from the Commonwealth’s General Fund.2
• Offset funding for uncompensated care from the Medical Assistance Trust Fund: $70,000,0003
1. $10,617,347 is used for HSN administrative funding.
2. $15M in funding for the Health Safety Net. $1M in additional funding for demonstration projects.
3. In FY23, disbursements were made to Cambridge Health Alliance ($50,000,000) and Boston Medical Center ($20,000,000) due to offset funding for uncompensated care from
other sources.
Executive Office of Health and Human Services
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 Introduction
HSN Overview
The HSN also allocates funds every fiscal year for demonstration projects designed to address
alternative approaches to improve health care and reduce costs for the uninsured and underinsured on a
cost-neutral basis.1 The following demonstration projects were funded in FY23:
• Fishing Partnership
• The Fishing Partnership was awarded demonstration funding to connect commercial fishermen
with a broad range of professional counseling services, provide assistance with health
insurance applications, and offer safety and survival trainings and other special health-oriented
events for fishing families: $2,000,000
• Long-Acting Reversible Contraception
• Two community organizations (Boston Medical Center and Upstream USA) were awarded
demonstration funding to provide assistance to health care providers, both in the community
and hospital settings, with the aim of decreasing the number of unintended pregnancies and
improving maternal and infant health outcomes across the Commonwealth: $2,086,638
• Note: Each fiscal year, the HSN makes a $1M payment to the Office of the Inspector General for
auditing purposes.
1. $50,000 of demonstration funding is used to pay for the HSN drug utilization review contract.
Executive Office of Health and Human Services
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 Introduction
HSN Fiscal Year 2023 Updates
• The HSN shortfall increased from $68M during HSNFY22 to $107M during
HSNFY23
• HSN received a hospital assessment of $875,000,000. It transferred
$710,000,000 to the Executive Office of Health and Human Services to
support MassHealth payment, clinical, health equity, and population health
initiatives. The Health Safety Net kept $165,000,000 of the overall hospital
assessment.
• The increase in shortfall is attributable to increased CHC demand, mandated
Medicare-based rate increases, and increased Medicare Savings Plan
contributions.
• The above shortfall amount is subject to change. The Health Safety Net does
not close a fiscal year until two years after its end date to allow for claim
adjustments and remediated claim submissions.
Executive Office of Health and Human Services
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 Payments
HSN Total Demand and Payment Trends
Demand represents the
amount that providers would
have been paid in the
$600,000,000 absence of a funding
shortfall.
$491 M
$500,000,000 $479 M
$451 M The HSN shortfall increased
$380 M 65 M 107 M from $68M during HSNFY22
68 M to $107M during HSNFY23
$400,000,000 20 M
91 M
78 M 86 M
69 M Hospital Payments includes
$300,000,000 $20M offset for BMC and
$43M in CHA demand paid
through it’s offset.
$200,000,000
323 M 305 M 298 M
291 M Note: In FY22, the HSN
$100,000,000 received a $16M
appropriation from the
Commonwealth’s General
Fund ($15 million towards
$-
HSN general fund and $1M
HSN 20 HSN 21 HSN 22 HSN 23
directly for demonstration
projects)
Hospital Payments CHC Payments Shortfall
Notes: Th e Health Safety Net fiscal year runs fr om O ctober 1 throug h S eptember 30 of the following yea r. Hospita l an d communi ty hea lth center payments are rep orted in the month in which payment was
made. Th e shor tfall amount is based on spending assumptions in place durin g the fiscal year and may differ fr om year -end shortfall estimates r eported elsewhere. Data reflect payment and projected
deman d le vels as of th e e nd of each fiscal ye ar and exclud e a djustments mad e a fter the end of the fiscal ye ar. Numbers are ro unded to the ne arest million and may n ot sum d ue to rou nding; percent
change s are calculated prior to r ounding . Source: Health Safety Net Pa yment Ca lcula tion as of 09/30/23. The above totals are s ubject to change t o allow for claim adjustm ents and re media ted
claim subm iss ions.
Executive Office of Health and Human Services
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 Amounts Disbursed to Hospitals from the Health Safety Net Trust Fund
and Offset Funding (after Shortfall) Payments
Hospital Payments Hospital Payments
Anna Jaques Hospital $ 489,714 Marlborough Hospital $ 1,835,703
Athol Memorial Hospital $ 244,671 Martha's Vineyard Hospital $ 2,350,097
Baystate Franklin Medical Center $ 430,011 Massachusetts Eye and Ear Infirmary $ 2,693,354
Total Hospital Disbursements
Baystate Medical Center $ 4,707,620 Massachusetts General Hospital $ 16,821,957
Mercy Medical Center $ 1,142,138
for FY23:
Baystate Wing Hospital $ 804,455
MetroWest Medical Center $ 1,182,773 $235,515,285
Berkshire Medical Center $ 3,130,904
Milford Regional Medical Center -
Beth Israel Deaconess Medical Center -
Morton Hospital, A Steward Family Hospital Inc. $ 639,593
Beth Israel Deaconess Hospital – Milton $ 201,776
Mount Auburn Hospital -
Beth Israel Deaconess Hospital – Plymouth $ 527,708
Nantucket Cottage Hospital $ 1,119,349 This represents the amount
Boston Children's Hospital $ 3,850,000 Nashoba Valley Med Ctr, A Steward Family Hospital $ 335,340 disbursed from the Health
Boston Medical Center $ 104,581,632 Newton-Wellesley Hospital - Safety Net Trust Fund to each
Brigham and Women's Faulkner Hospital - Noble Hospital $ 266,467 Hospital during HSN fiscal
Brigham and Women's Hospital - North Shore Medical Center $ 5,616,188
year 2023 and offset funding
Cape Cod Hospital $ 6,522,225 Northeast Hospital $ 1,608,794
Saint Vincent Hospital $ 775,031
from outside sources.
Cooley Dickinson Hospital