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To extend insurance coverage to all residents, Massachusetts legislation expanded Medicaid eligibility and added new private insurance categories. To date, no one has analyzed the effect of these changes and compared recent trends in total hip arthroplasty (THA) utilization. Therefore, this study sought to update the current trends of THA utilization in Massachusetts from 2013 to 2015. The Massachusetts State Inpatient Database was queried for all patients who underwent primary THA between 2013 and 2015, and 30,308 patients were identified. Analyzed variables included age, sex, race, Charlson Comorbidity Index, median household income, primary payer, discharge disposition, length of stay, hospital charges, hospital costs, and complications. Categorical and continuous variables were assessed using chi-square analyses and analyses of variance, respectively. Between 2013 and 2015, annual THAs increased from 9361 to 10,562. Race did not vary significantly ( P =.447), although an increase in patients using Medicaid and a decrease in patients using other insurance was observed ( P <.001). Patients with an income quartile of 1 increased, whereas the number of THA patients in quartile 3 decreased ( P <.001). There was a decrease in both hospital charges ( P <.001) and costs ( P <.001). Mean length of stay decreased ( P <.001), and the number of patients with complications decreased ( P <.001). Massachusetts has been successful in increasing access to THA procedures for low-income patients and increasing the number of patients who use Medicaid for THAs. The current delivery of health care in Massachusetts has shown improvement for its residents, serving as an example that other states can learn from. [ Orthopedics . 2021;44(2):e167-e172.].