BOSTON Massachusetts has started signing up its poorest residents for low-cost health insurance.

It's the first step in the Massachusetts state's the aim to be the first to require all citizens to have health insurance.

This summer, the federal government gave the state its support to a first-in-the-nation plan, which would require everyone 18 and older to carry health insurance. The state's universal health insurance program would use a combination of subsidies and penalties to make coverage more affordable and also to encourage people to buy it.