Maintaining Affordable Health Coverage in Massachusetts

Suzanne CurryHealth Care For Allscurry@hcfama.org

Families USA Health Action 2015January 23, 2015

Massachusetts Health Reform 2006

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Determining Affordabilityo Community Catalyst study looked at:

Greater Boston Interfaith Organization Study MassFESS (Family Economic Self-Sufficiency

Standard)Economic Policy Institute Basic Family Budget

o Showed people <300% FPL barely have enough income to cover basic needs (before health care costs)

Commonwealth Care

o Comprehensive health coverage for adults at or below 300% FPL not eligible for MassHealth (Medicaid)

o Run by the Health Connector (MA marketplace)

o Sliding scale premiums based on income, copays also based on income: Plan Types 1, 2, 3

o Cannot be offered health insurance from job

o As of December 31, 2013, about 220,000 enrollees

Why State “Wrap”* Needed

Income $11,916 $23,900 $35,500

ConnectorCare Premiums

ACA Premiums

* “ConnectorCare”

ACA vs. MA Premiums & Cost Sharing

ConnectorCareo Coverage designed to look like Commonwealth

Careo Eligibility

o Meet eligibility standards for federal APTCso Income at or below 300% FPLo Must choose from subset of plans offered

through the Health Connector (mostly Medicaid MMCOs)

ConnectorCare Premiums

ConnectorCare Cost-Sharingo Co-pays only; no deductibles or co-insuranceo Mirrors actuarial value of Commonwealth Care

o Plan Type 1 (at or below 100% FPL): Medicaid-level co-pays (for prescription drugs only) (~99% AV)

o Plan Type 2 (100-200% FPL): Low to moderate co-pays (~97% AV)

o Plan Type 3 (200-300% FPL): Moderate co-pays (~95% AV)

ConnectorCare Fundingo Federal APTCs + Federal Cost-Sharing Reductions +

State Funds = ConnectorCare Subsidieso FY2015 Budget estimated cost at $235 milliono State funding sources include a portion of the

cigarette tax, individual mandate penalties, employer assessment

o 50% federal reimbursement for premium wrap portion only (for citizens and qualified immigrants) through 1115 Medicaid Demonstration waiver

Thank you!

Questions?