Chapter 58 of the Acts of 2006 established the Health Safety Net (HSN) as a critical mechanism to reimburse uninsured care. After 20 years of essentially level financial support, the HSN is under significant strain from a growing funding shortfall and changes at the federal level that have presented a new challenge to ensuring access to medically necessary care for residents. As Medicaid changes made by the One Big Beautiful Bill Act (OB3) are phased in through 2028, MTF estimates more than 255,000 Massachusetts residents could lose health insurance, presenting new financial challenges for policymakers to support uninsured and underinsured care.

This brief provides a review of the Health Safety Net, examining the role of the Health Safety Net Trust Fund in the health care system, program and funding trends, and the new challenges that lie ahead.