Health New England

What it reported doing in 2024

Commercial small and large group and individual products: enrollees at 12/31/24: 48,022 revenue: $ 389.3 millionprogram expenses: $ 329.3 millionhealth new england, inc. Makes high quality, low cost health care services available through health plans within a service area that comprises more poor, medically underserved and rural communities than any other part of Massachusetts. A federal health resources & services administration report stated that of the 102 Massachusetts towns designated as medically underserved, 78 are in the four counties that health new england serves. (continued on schedule o) based on that statistic, in all over 45% of health new england's enrollees live in medically underserved areas.health new england's service area includes four of the five counties with the highest percentage of poverty and the lowest per capita income in Massachusetts, based on us census bureau data. Many residents in western Massachusetts thus struggle with poverty and low levels of income. Across the four counties of western Massachusetts, 16% of residents live in poverty, and the median family income in three of the four counties is more than 20% lower than that of the state. Child poverty rates are high with 23% of children in the region living in poverty. Hampden county has the highest rates of poverty and unemployment in health new england's service area and the lowest median income. Also, lower levels of education contribute to unemployment and the ability to earn a livable wage. Approximately 12% of residents age 25 and older in western Massachusetts do not have a high school diploma, with the highest rates observed in hampden county (16%). In the communities of springfield, holyoke, chicopee, ludlow, west springfield and pittsfield, there is a higher percentage of eligible individuals do not have a high school diploma, compared to statewide rate.health new england makes health care available in this service area and to this population by offering health plans which serve individuals and small groups.health new england offers health plans to individuals and families (both directly and through the Massachusetts health connector) and small employer groups (employers with 50 or fewer employees).health new england also provides coverage to individuals and families through plans offered by employers which have more than 50 employees. This category includes many municipal employees who do not obtain coverage through the gic, and also includes many employees of health care and nonprofit organizations.medicare: enrollees at 12/31/24: 12,175revenue: $145.5 millionprogram expenses: $130.7 millionhealth new england serves medicare enrollees through health new england medicare advantage plans.medicaid: enrollees: 48,315revenue: $446.7 millionprogram expenses: $417.9 millionhealth new england participates in masshealth, the Massachusetts medicaid program, through a medicaid managed care plan. The number of health new england's medicaid plan enrollees has generally increased since 2010 when health new england began offering such plans.

Financial Efficiency

• Mission deployment rate: 88.1%; rating input score 88
• Program expense ratio: 90.5%; rating input score 90
• Fundraising efficiency: Limited

Transparency & Controls

• Consistency checks: 93.3%; rating input score 93; 24th percentile among comparable filings
• Pay-setting controls: 4 of 6 controls in place; rating input score 67
• Foreign activity oversight: Limited
• Grant itemization coverage: 80.6%; rating input score 81; 17th percentile among comparable filings
• Major donor itemization: Limited
• Related-party transparency: Limited
• Public monitoring controls: 0 of 8 controls in place; rating input score 0
• Public policy transparency: 1 of 7 controls in place; rating input score 14
• Public financial transparency: 0 of 5 controls in place; rating input score 0
• Impact reporting controls: 0 of 7 controls in place; rating input score 0
• Public relationship transparency: No; rating input score 0

Accountability

• Independent voting board: 71.4%; rating input score 71; 20th percentile among comparable filings
• Governance controls: 9 of 9 controls in place; rating input score 100
• Public governance controls: 1 of 4 controls in place; rating input score 25
• Zakat policy transparency: Limited

Sustainability

• Operating margin: 2.1%; rating input score 43; 43rd percentile among comparable filings
• Operating reserve ratio: 0.3; rating input score 10; 10th percentile among comparable filings
• Liabilities to assets ratio: 0.72; rating input score 20; 20th percentile among comparable filings
• Officer compensation ratio: 0.8%; rating input score 78; 78th percentile among comparable filings

Growth

• Program expense growth: 1% per year; rating input score 100; 11th percentile among comparable filings
• Revenue growth: 1.3% per year; rating input score 100; 10th percentile among comparable filings
• Asset growth: 6.5% per year; rating input score 100; 48th percentile among comparable filings