maintaining affordable health coverage in massachusetts suzanne curry health care for all...
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Maintaining Affordable Health Coverage in Massachusetts
Suzanne CurryHealth Care For [email protected]
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?