The bill outlines the requirements for the Executive Office of Health and Human Services to submit a report detailing the methodology used for projecting caseload and utilization for MassHealth, as mandated by line item 4000-0300 of Chapter 140 of the Acts of 2024. The report highlights the significant growth in MassHealth enrollment, particularly during the COVID-19 pandemic, and the subsequent resumption of eligibility redeterminations. As of May 2024, the caseload was approximately 2.1 million members, which remains consistent as of December 2024. The report also discusses the implementation of a new caseload forecasting methodology developed in collaboration with a professor from Northeastern University, which aims to improve accuracy in projections.

Additionally, the report details the utilization and price methodology for MassHealth's managed care capitation programs, which involves contracting with a healthcare consulting firm to develop actuarially sound capitation rates based on historical data. The methodology includes adjustments for new drug therapies and other factors affecting costs. MassHealth also collaborates with the Center for Health Information and Analysis for its Fee-for-Service rate-setting activities, utilizing historical data to project future utilization and total spending for the fiscal year. The report emphasizes the importance of these methodologies in ensuring effective management of MassHealth resources and services.